A multi-method study to identify and validate alcohol diagnostics for injury-related trauma in South Africa: a study protocol

ABSTRACT Introduction The burden of alcohol use among trauma patients and the relative injury risks is not routinely measured in South Africa (SA). Given the prominent burden of alcohol on hospital trauma departments, SA needs practical, cost-effective and accurate alcohol diagnostic tools for testing, surveillance and clinical management of trauma patients. This study aims to validate alcohol diagnostics for injury-related trauma and assess its utility for improving national health practice and policy. Methods and Analysis The Alcohol Diagnostic Validation for Injury-Related Trauma (AVIRT) study will use mixed methods across three work packages. Focus Group Discussions will be conducted with key stakeholders across four areas of expertise (clinical, academic, policy and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and healthcare sectors. We will then conduct a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, finger-prick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting alongside community-based participatory research on the utility of the selected tools. Ethics and dissemination The study was approved by the Research Ethics Committee of the South African Medical Research Council and the Western Cape Health Department. Findings will be disseminated to inform strategies to introduce routine, cost-effective alcohol diagnostics optimally in a high trauma setting by ensuring accuracy, real world feasibility and institutional support. Strengths and limitations of this study The study will provide an understanding of the impact of alcohol and its association with injuries, highlight the burden alcohol-related injuries impose on health workers, inform policies to mitigate alcohol harm, and recommend methods to scale-up alcohol screening and detection in trauma patients nationally. The study setting will complement the limited evidence base on alcohol consumption in LMICs. Expert stakeholders included in focus group discussions will be restricted to known contacts within the field. Validity testing of the alcohol diagnostics will use enzyme immune assay instead of the gold standard gas chromatography method, which was too expensive. Results will be generalisable to patients treated at public-sector district and tertiary-level facilities, that treat a higher proportion of moderate to severe injuries.