Feasibility and utility of routine blood alcohol level testing for trauma patients: An observational study done at a tertiary level referral hospital in Rwanda, Kigali University Teaching Hospital, in the emergency department

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