Jour, al o f Cli, ical Forensic Medicine (1999)6, 141 144 © APS/HarcourtPubIishers Ltd 1999 ORIGINAL COMMUNICATION Reliability of clinical decisions regarding alcohol influence H. A. Abder-Rahman, K. A. Hadidi, A. H. Battah Forensic Medicine and Toxicology Division, Faculty of Medicine The University of Jordan, Ammam, Jordan SUMMARY. 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. Journal o f Clinical Forensic Medicine (1999) 6, 141-144 INTRODUCTION Problems related to alcohol intake are a major con- cern in Western societies since it is a common part of social life. This obliged the legal authorities in certain countries such as UK and the USA to specify a legal level of blood alcohol concentration (BAC) for driv- ing.l.2 In contrast, alcohol intake is a sensitive issue in certain communities, like Jordan, who disapprove of the habit, for social and religious reasons. 3 The law in Jordan does not require the estimating of BAC in per- sons suspected of an offence. Alcohol intake is only considered an offence if the drinker is under the influ- ence of alcohol and endangers the lives of others. The law for this purpose requires a medical report to state whether the person is under the influence of alcohol. Alcohol produces central nervous system (CNS) depression; 4 the CNS impairment increases with the elevation of alcohol in blood. 5 Dr H. Abder Rahman MD, PhD, K. A. Hadidi PhD, A. H. Battah MD~ PhD, Forensic Medicine and Toxicology Division, Faculty of Medicine, The University of Jordan, Amman, Jordan. Correspondence to." Dr. H. Abder Rahman, Tel. +962 6 535 5000, Ext: 2460; fax: +962 6 535 5655; e-mail: toxico@ju.edu.jo Many variables other than BAC, such as physician experience, patient tolerance, age and sex, could affect clinical presentations. In countries where physicians' reports, rather than BAC, are still the only evidence accepted in the pursuit of a legal procedure, there are no data in the literature evaluating the reliability of physicians' decisions in such cases. This study exam- ines physician clinical-judgment ability with regard to patients suspected of being under the influence of alcohol and the impact on legal consequences. 141 MATERIALS AND METHOD During the period from September 1993 to August 1995, 825 medico-legal cases of road traffic accidents (RTA) persons found collapsed persons detained by the police and suicide attempts were studied. They included 104 cases with positive BAC. Another 171 cases with negative BAC of matching age, sex and accident type were utilized as a control group. Both groups were compared for their clinical manifesta- tions, BAC, circumstances of presentations, age, type and severity of trauma. Determination of BAC was conducted at Jordan University Hospital/toxicology laboratory as described earlier. 6