Home > Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit.

Ismail, Muhammad Fahmi and Doherty, Kieran and Bradshaw, Paula and O'Sullivan, Iomhar and Cassidy, Eugene M (2019) Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit. Emergency Medicine Journal , 36 , (1) , pp. 18-21.

INTRODUCTION
We previously reported that benzodiazepine detoxification for alcohol withdrawal using symptom-triggered therapy (STT) with oral diazepam reduced length of stay (LOS) and cumulative benzodiazepine dose by comparison with standard fixed-dose regimen. In this study, we aim to describe the feasibility of STT in an emergency department (ED) short-stay clinical decision unit (CDU) setting.

METHODS
In this retrospective cohort study, we describe our experience with STT over a full calendar year (2014) in the CDU. A retrospective chart review was conducted and data collection included demographics, clinical details, total cumulative dose of diazepam, receipt of parenteral thiamine, LOS and disposition.

RESULTS
5% (n=174) of 3222 admissions to CDU required STT. Collapse or seizure (41%, n=71) and alcohol withdrawal (21%, n=37) were the most common reasons recorded for admission to CDU in those who required STT. Median Alcohol Use Disorders Identification Test score was 25 and 112 patients (64%) had at least one Clinical Institute Withdrawal Assessment for Alcohol revised measurement ≥10, triggering a dose of diazepam (20 mg). The median cumulative oral diazepam dose was 20 mg while 24 (15%) patients received a cumulative dose of 100 mg or more. Median time for STT was 12 hours (IQR=12, R=1-48). 3% (n=5) of patients required further general hospital admission and median LOS in CDU, was 22 hours (IQR=20, R=1-168).

CONCLUSION
STT is potentially feasible as a rapid and effective approach to managing alcohol withdrawal syndrome in the ED/CDU short-stay inpatient setting where patient LOS is generally less than 24 hours.


Item Type:Article
Date:2019
Page Range:pp. 18-21
Publisher:BMJ Publishing
Volume:36
Number:1
EndNote:View
Related URLs:
Subjects:B Substances > Sedatives or tranquillisers (CNS depressants) > Benzodiazepine
G Health and disease > Substance use disorder > Alcohol use > Alcohol withdrawal syndrome
J Health care, prevention and rehabilitation > Care by type of problem > Emergency care
J Health care, prevention and rehabilitation > Health care programme or facility > Hospital
VA Geographic area > Europe > Ireland
VA Geographic area > Europe > Ireland > Cork

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