Hack's Impairment Index, Response to Comments

Abstract

The fact that alcohol intoxication is a tremendous problem with hundreds of thousands of patients presenting to EDs across the country with impairment as a chief complaint and no nationally recognized standard way of evaluating this state (or even language to formally describe their clinical status) emphasizes the importance of this paper. Although the paper describes the performance of Hack's Impairment Index (HII score) in the largest group of alcohol impaired ED patients ever formally assessed for degree of impairment and the first to include patients that ranged from unresponsive to unimpaired, the research was limited in several aspects by restrictions imposed by the hospital and IRB, and the nature of the study population, which all affected study design. Many of these limitations are inherent in any study exploring a new gold standard—in that there is no objective mean for the desired primary outcome of patient safety.

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