Recognising intoxication in healthcare: evidence, challenges, and implications

Area of Science:

• Clinical Medicine
• Toxicology
• Healthcare Management

Background:

• Intoxication presents significant clinical challenges, including unreliable patient histories and increased risks of harm.
• Despite its prevalence, clinicians frequently misidentify intoxication or underestimate its severity, impacting patient care.
• Existing research highlights a gap in understanding clinician recognition of alcohol and other drug intoxication.

Purpose of the Study:

• To synthesize literature on clinician recognition of alcohol and other drug intoxication.
• To identify challenges contributing to misclassification of intoxication.
• To explore potential solutions for improving intoxication identification in healthcare settings.

Main Methods:

• This narrative review synthesizes existing literature on clinician recognition of intoxication.
• Analysis focuses on challenges in identifying mild to severe intoxication across various substances.
• The review examines the effectiveness and limitations of current assessment tools.

Main Results:

• Misclassification is most common in mild to moderate intoxication due to subtle signs and individual variability.
• Severe intoxication is more reliably identified, but this offers limited benefit for early risk detection.
• Structured assessment tools show weak correlations with biological measures and have limited feasibility in routine practice.
• Clinician accuracy does not consistently improve with experience, and evidence for non-alcohol substance intoxication detection is limited.

Conclusions:

• Improving intoxication recognition requires enhanced clinician training and validated, practical assessment tools.
• Addressing misclassification is essential for patient safety, informed consent, diagnostic accuracy, and appropriate service utilization.
• Further research is needed to validate tools and improve accuracy across diverse clinical contexts.