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24 It is important to note that this study provided estimates of the assignation of alcohol intoxication codes. These estimates should be considered as tentative until such time as we have information on the accuracy of the coding. Our estimates were compromised by what we consider to be a shortcoming in the ICD code [http://en.wikipedia.org/wiki/Carboplatin Carboplatin] Y90. It has the label ��Evidence of alcohol involvement determined by blood alcohol level��. This implies that the lowest category, Y90.1 [http://www.selleckchem.com/products/BI6727-Volasertib.html BI-6727] zero. Finally, our dimension of serious injury was injury with a high threat to life. Other dimensions of importance include high threat to disability and high cost. Given that the concordance between these dimensions is not high,25?and?26 different proportions may be observed if these dimensions were explored. The American College of Surgeons recommends that all level I and II trauma centres implement alcohol screening and brief intervention as part of routine trauma care.27 It should be noted that this recommendation is intended to prevent the recurrence of injury. The College makes no recommendations about the assessment of BAC in the context of injury management. This suggests such an assessment is, in general, not important to the management of serious injury. That being the case there are major barriers to the assessment of BAC by the taking of blood or breath samples for the purposes of monitoring rates of serious alcohol-related harms in the population. Perhaps the most significant of these is ethical. In many countries this would require informed consent that would not be forthcoming for a significant portion of cases.28 Such [http://www.selleckchem.com/products/3-deazaneplanocin-a-dznep.html Selleck DZNeP] consent would also be required for any blood samples obtained for other purposes where subsequently an investigator wished to use it to determine BAC. Other barriers include the reluctance of health professionals to make objective assessments of alcohol intoxication due to privacy concerns, cost, and legal consequences.29 Finally, the use of breathalyzers to estimate BAC is expensive and unavailable in many countries.30 Given that clinicians accept that they have a significant role to play in health promotion, an alternative and less problematic option is to have a clinical judgement of intoxication. An international study involving 12 countries has demonstrated a moderate degree of concordance between clinical assessment and BAC in emergency room settings.