Stellpflug Samuel J, Menton William H, Westgard Bjorn C, Johnsen Ryan D, Coomes Alexander M, LeFevere Robert C, Zwank Michael D
Regions Hospital, Department of Emergency Medicine, Saint Paul, Minnesota.
VA Healthcare System, Minneapolis, Minnesota.
West J Emerg Med. 2025 Mar;26(2):364-366. doi: 10.5811/westjem.24998.
The gold standard for quantifying ethanol intoxication in patients is serum testing. However, breath testing is faster, less expensive, and less invasive. It is unknown whether perceived effort during a breath ethanol test impacts the accuracy of the test and the correlation with serum concentration. In this study we analyzed whether perceived "poor" effort during breath ethanol testing would result in worse correlation than perceived "normal" breath-testing effort with respect to serum ethanol concentration.
Subjects were identified retrospectively over a 49-month period if they had both a breath ethanol test and a serum ethanol test obtained during the same ED visit within 60 minutes of each other, if they had their effort during the breath test recorded as "normal" or "poor" by the person administering the test, and had non-zero breath and serum ethanol concentrations. We completed descriptive and correlation analyses.
A total of 480 patients were enrolled, 245 with normal and 235 with poor effort. The patients with normal breath-test effort had mean breath and serum concentrations of 0.19 grams per deciliter (g/dL) and 0.23 g/dL, respectively. The patients with poor breath-test effort had mean breath and serum concentrations of 0.19 and 0.29 g/dL, respectively. The correlation coefficient between breath and serum ethanol values was 0.92 (95% confidence interval (CI) 0.84-0.96) for good effort and 0.63 (95% CI 0.53-0.74) for poor effort.
The assessment of breath exhalation effort is meaningful in determining how well a patient's breath ethanol level correlates with the serum ethanol concentration. Poor breath effort, when compared to normal breath effort, was associated with higher ethanol levels as well as a larger difference and a greater variability between breath and serum values. If an accurate ethanol level is important for clinical decision-making, a physician should not rely on a poor-effort breathalyzer value.
对患者乙醇中毒程度进行量化的金标准是血清检测。然而，呼气检测更快、成本更低且侵入性更小。呼气乙醇检测时的主观努力程度是否会影响检测准确性以及与血清浓度的相关性尚不清楚。在本研究中，我们分析了呼气乙醇检测时主观感觉“不佳”的努力程度与主观感觉“正常”的呼气检测努力程度相比，在血清乙醇浓度方面是否会导致更低的相关性。
回顾性确定在49个月期间内符合以下条件的受试者：在同一次急诊就诊期间，在60分钟内先后进行了呼气乙醇检测和血清乙醇检测；呼气检测时的努力程度被检测执行者记录为“正常”或“不佳”；呼气和血清乙醇浓度均不为零。我们完成了描述性分析和相关性分析。
共纳入480例患者，其中245例努力程度正常，235例努力程度不佳。呼气检测努力程度正常的患者，呼气和血清平均浓度分别为每分升0.19克（g/dL）和0.23 g/dL。呼气检测努力程度不佳的患者，呼气和血清平均浓度分别为0.19和0.29 g/dL。努力程度良好时，呼气与血清乙醇值的相关系数为0.92（95%置信区间（CI）0.84 - 0.96），努力程度不佳时为0.63（95%CI 0.53 - 0.74）。
评估呼气努力程度对于确定患者呼气乙醇水平与血清乙醇浓度的相关性具有重要意义。与正常呼气努力程度相比，呼气努力程度不佳与更高的乙醇水平相关，同时呼气与血清值之间的差异更大且变异性更大。如果准确的乙醇水平对临床决策很重要，医生不应依赖努力程度不佳的呼气酒精检测值。
