Blood alcohol concentration in intoxicated patients seen in the emergency department: does it influence discharge decisions?

Objective: The purpose of this study was to investigate whether blood alcohol concentration (BAC) measurement was routinely requested in emergency departments and whether the observation period in the emergency department allowed sufficient time for alcohol elimination before the patient was discharged.

Method: A retrospective review of medical records of all emergency alcohol-related admissions over a 12-month period from January 2012, in patients older than 18 years, was conducted. We estimated BAC at discharge for each patient by using the following formula: [BAC at admission--(length of stay × 15)]. Then, we focused on patients discharged from the emergency department with an estimated BAC greater than 50 mg/100 ml because of the risk of subsequent legal proceedings, because this is the legal limit for driving in France.

Results: A total of 907 patients admitted for acute alcohol intoxication (F10.0) were included, of whom 592 were male. Women were more likely to be admitted at night. The mean length of stay was 18.7 hours. BAC was measured in 893 patients. Patients ages 35-49 years had the highest measured BAC. No repeat BAC was taken before the discharge decision. Three hundred thirteen patients were discharged with an estimated BAC above 50 mg/100 ml.

Conclusions: Emergency physicians routinely requested BAC at admission but did not request alcohol kinetics while the patient was under observation. The discharge decision was based on clinical judgment. Doctors who do not advise patients appropriately before discharge may be guilty of negligence in their duty of care.