Comparison of 4 tests' utility for predicting need for emergency department care in patients with alcohol-related complaints.
INTRODUCTION
Intoxication is a common presenting complaint in emergency departments (ED), but many patients with intoxication do not need emergency care. Three screens (BLINDED, Brown, and San Francisco) attempt to determine which intoxicated patients can be triaged to a lower level of care.


METHODS
Observational multi-center cohort study of patients presenting to one of three ED with complaints consistent with acute intoxication. When a qualifying patient was brought to the emergency department, a team member interviewed the triaging provider. Interviews covered all three screens and the provider's gestalt. Receiver operating curve (ROC) analysis was used to determine which screen performed best. Cases were reviewed to determine need for emergency care.


RESULTS
Of the 199 subjects studied, 91% (181/199) were male and were 50 years old on average (SD = 12 years). Of the 55 subjects tested (28%), their average alcohol level was 251 mg/dL (SD = 146 mg/dL). Only 117 subjects (59%) had complete information for inclusion in the final comparison of screens. Provider gestalt performed best (AUC = 0.69), but there were no meaningful differences between any of the screens (AUC = 0.62-0.66, p > 0.05 for all comparisons). Inability to sit up was sensitive for needing emergent care (88%), but it was non-specific (17%). Similarly, signs of trauma were specific (99%) for ED care, but insensitive (18%).


CONCLUSIONS
The three formal screens and provider gestalt performed similarly.
['Leslom|Salman|S|', 'Patel|Sumit|S|', 'Sommerkamp|Sarah|S|', 'Dezman|Zachary D W|ZDW|']
D000435:Alcoholic Intoxication D004636:Emergency Service, Hospital D005260:Female D006801:Humans D008297:Male D008403:Mass Screening D008875:Middle Aged D011237:Predictive Value of Tests D014218:Triage
Screening Stabilization center Substance use disorders