Abstract:
Introduction
The blood alcohol concentration (BAC) is measured in trauma patients in developed countries and
results in changes in clinical management. Rwanda holds the 9th place in Africa in terms of trauma and
it is on the 2nd place in matter of alcohol consumption. The most recent data from 2013, according to the
Rwanda National Police records, showed that 349 traumatic injuries were treated at CHUK of which
60% were under the influence of alcohol and 45% of them died.
Methods
The study was a prospective observational, single center study of 304 patients done at a tertiary level
hospital, CHUK in Kigali Rwanda from October 2018 to January 2019. All patients had a GCS greater
than 14 after physician evaluation. After the initial management plan, physicians had the option to obtain
a BAC measure and we assessed if this changed management. We measured changes to management by
looking at ED outcomes (discharge, admit) and CT scan orders.
Results
304 patients with traumatic injuries were screened and enrolled in the study. The blood alcohol level
was requested in 257(84.54%) patients and it was not requested in 47(15.46%) patients. In those whom
the blood alcohol level was requested, 127(41.77%) had positive results with the average BAC of 0.09
and 130(42.77%) had negative results. 73.68% (14/19) of physicians at the emergency department
confirmed that BAC testing in patients helped in the decision making and it changed management. CT
scan orders quadrupled (OR = 4.62, p<0.0001) after BAC orders. Furthermore, the number of discharges
doubled (OR = 2.02, p<0.0001) after BAC orders.
Conclusion
The measurement of BAC changed the physician’s plan and helped both patients and the ED staff. The
treating physician has to consider other factors beyond the clinical examination including CT scans.
Routine measurement of BAC could increase in discharges and decrease length of stay, save money and
decrease overcrowding of the ED
