Journal Club – 18th April 2018

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



  1. Diccon says:

    Hi Guys

    Love the idea of journal club and a valuable addition to the dept educational programme.
    Have you considered podcasting the conversation on here or such? For those that cannot attend.
    Maybe you can output the audio from the video link???

    • embeds says:

      yes – you may be hearing Darren and my dulcet tones i the coming months

      but if you can’t come – feel free to read the paper and post comments – all comments welcome

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