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Blood alcohol and injury in Bhutan: targeted surveillance in a national referral hospital emergency department
  1. Gampo Dorji1,2,
  2. Sona Pradhan3,
  3. Tashi Tenzin3,
  4. Peter Miller4,
  5. Jennie Connor5,
  6. Kypros Kypri1
  1. 1School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  2. 2Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
  3. 3Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
  4. 4School of Psychology, Deakin University, Geelong, Victoria, Australia
  5. 5Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  1. Correspondence to Professor Kypros Kypri, School of Medicine & Public Health, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia; kypros.kypri{at}


Bhutan is a low-middle-income country with poor roads, rapidly increasing motor vehicle use and heavy alcohol consumption. We estimated the proportion of emergency department patients presenting with injury who had positive blood alcohol. We sought to breathalyse and interview all adult patients (≥18 years) presenting with injury at the Jigme Dorji Wangchuck National Referral Hospital in the capital city Thimphu, from April to October 2015. Breath tests and interviews were conducted with 339 (91%) of 374 eligible adult patients. A third (34%) were alcohol-positive and 22% had blood alcohol concentrations >0.08 g/dL. The highest alcohol-positive fractions were for assault (71%), falls (31%) and traffic crashes (30%). Over a third (36%) of patients had a delay of >2 h between injury and breath test. The results underestimate blood alcohol concentrations at the time of injury so the true prevalence of pre-injury alcohol impairment is greater than our estimates suggest. Countermeasures are urgently needed, particularly roadside random breath testing and alcohol controls.

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  • Contributors GD and KK designed the study with input from PM and JC. GD and KK obtained ethical approvals. SP and TT oversaw the study implementation in the emergency department and checked the data. GD and KK analysed the data and drafted the manuscript. All of the authors commented on the draft manuscript and approved the final version.

  • Competing interests None declared.

  • Ethics approval Ministry of Health, Bhutan, and University of Newcastle Human Research Ethics Committee, Australia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data will be made available in an open access repository on publication of the paper.