The Reliability and Validity of the Alcohol Intoxication Scale

Purpose:
The emergency department(ED)and behavioral health(BH)unit developed a behaviorally based alcohol intoxication scale (AIS)to assess when patients can be safely transferred to the BH unit from the ED. The purpose of this study was to determine the reliability and validity of the scale.

Background/Significance:
Research has shown that there is not a strong correlation between blood alcohol levels (BAL) and a patient's symptoms of intoxication; therefore, the BAL might not be the best indicator of a patient's intoxication level. A review of the literature found no behaviorally based screening tools to assess when patients can be safely transferred or discharged. As EDs are faced with large numbers of patients admitted with alcohol problems, a reliable/valid tool is needed to correctly assess patients.

Methods:
Patients in the ED with an elevated blood alcohol level were used to assess the inter-rater reliability of the scale. Two people (MD/RN) independently assessed each patient at the same time and scored the AIS. A Bland-Altman plot of the differences between the two AIS scores was plotted against the means of the two scores. To assess for criterion-related validity of the scale, the charts of 87 subjects who had at least one AIS on the chart were reviewed in BH to determine whether or not there were any issues after the patients were transferred to BH using the AIS instead of the blood alcohol level. A power analysis was computed to determine sample size needed for both arms of the study.

Results:
The AIS has five components on which patients are assessed: Alertness/Orientation, Gait, Speech, Agitation, and Physical Assessment. On average, the nurses' scores were 0.1111 higher than the physicians' scores, but this difference was not statistically significant. Krippendorff's Alpha was used to assess inter-rater reliability, which yielded an alpha of 0.9396, thus demonstrating reliability of the scale. Support for the validity of the scale was demonstrated as all of the patients were safely transferred to the BH unit as indicated by no Rapid Response or Code Blue Calls as well as no patients transferred to a med-surg unit within 24 hours of admission.

Conclusions and Implications for Practice:
Further studies need to be conducted to determine the sensitivity/specificity of the AIS. This scale has been used by SANE nurses to determine when sexually assaulted patients can be consented. Also, local Fire and Police are using it to assess when individuals should be transferred to the ED.