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

Abstract

Background: Emergency Departments (EDs) care for thousands of alcohol-intoxicated patients annually. No clinically relevant bedside measures currently exist to describe degree of impairment. Objectives: To assess a group of bedside tests (“Hack's Impairment Index [HII] score”) that applies a numerical value to the degree of alcohol-induced impairment in ED patients. Methods: A six-month retrospective review of HII score data was performed in a convenience sample of 293 intoxicated ED patients. Patients were scored 0–4 on five tasks, divided by the maximum score (20 if all tasks completed), every 2 hours; and classified by the number of visits: Low-frequency (1 visit); Medium-frequency (2 visits); High-frequency (≥3 visits). Correlations were assessed between HII score, healthcare provider judgment of intoxication, and measured alcohol levels. Results: Study patients had 513 visits; 236 were low-frequency, 26 middle-frequency and 31 high-frequency. Clinical assessment and HII score were strongly correlated (Spearman’s rho = 0.82, p << 0.001); clinical assessment and alcohol level less strongly so (rho = 0.49, p << 0.001). Among low-frequency patients, HII score and alcohol level were weakly correlated (r = 0.324, p < 0.001), with no such correlation among high-frequency visitors (r = −0.04, p = 0.89). The mean decline between serial HII scores was 0.126 (95% CI: 0.098–0.154). Conclusion: This pilot study shows the HII score can be performed at the bedside of alcohol-intoxicated patients. The HII declines in a reasonably predictable manner over time; and applies a quantitative, objective assessment of alcohol impairment.

• Alcohol intoxication
• assessment
• impairment
• score

Acknowledgements

The authors would like to acknowledge the work of Robert Medairos for data transfer, and the Department of Nursing at Rhode Island Hospital for their support of the study.