The H-Impairment Index (HII): a standardized assessment of alcohol-induced impairment in the Emergency Department

• Reported Result

  In intoxicated patients the HII score shows a predicable improvement in sobriety over time, and agreed with staff assessment of sobriety

  Our Opinion

  Overall: a reasonable paper however needs further validation

  Issues highlighted

  • Internal validity
    • Small Study: only looked at 120 patients over 6 months
    • Convenient sample: what information was missed, potential source of bias
    • Retrospective: how much data was lost would this have influence outcome.
    • Bias: how did using the HII score, influence how drunk staff thought patients were, and vice versa did staff perception influence the scoring of the HII score?
    • Loss of data: exclusion of patients who had suspicions results recorded (improved validity to final answer, but may not reflect real world use)
  • External validity
    • Population: Similar sized ED, with similar standard of assessing if patient was “drunk” and not medically unwell.
    • Single site: one hospital in USA, would we get the same result in our population?
  • Results: study states that if maximally intoxicated (score=1), will improve predictably by 1/8 every 2 hours to sobriety (score=0). As you would expect that the number of patients in the study dropped off quickly. 120 patients had results from 0-2hrs, only 65 had results from 2-4hrs and 29 had results from 4-6 hr. So has this really shown a predictable improvement.
  • Discussion
    • An interesting paper that currently we can’t take into our current practice with out validation.
    • Potential Benefits: highlighting those patients that are deteriorating or not improving as expected, in a measurable manner, and thus triggering reassessment for missed medical issues.
    • Potential Problems: staff training and time to perform