Reliability of clinical decisions regarding alcohol influence.

In Jordan, pursuing legal procedures related to alcohol intake usually depends on the physicians' clinical judgment. A study was carried out on 825 medico-legal cases over a 2 year period to evaluate the extent of physicians' clinical decisions on patients suspected to be under the influence of alcohol. A significant number of cases (12.6%, n = 104) were found to be positive for alcohol. The study showed that the clinical examination failed to diagnose a large number of cases (78.9%, n = 82). Also, the majority of diagnosed cases (50%, n = 11) had a blood alcohol concentration (BAC) range of 50-100 mg/dl. 32% (n = 33) of the cases with positive BAC were admitted to hospital. A high admission rate was observed when BAC was <50 mg/dl and >150 mg/dl, which constituted 39.3% (n = 13) and 48.5% (n = 16) of the admitted cases respectively. A large number of the admitted cases had either simple or no trauma (48.4%, n = 16) as compared with the control group of cases (21.8%, n = 10). The admission rate of positive BAC cases in traffic accidents was double that of control group. These findings may reflect the unreliability of the clinical decision in positive BAC. Implementing a certain BAC level locally for both clinical and a jurisdiction purposes is strongly recommended.