Improving Care for Inpatient Alcohol Withdrawal Syndrome: Addressing the Lack of Rigorous Research on a Common Condition

Steel, Tessa L.; Bradley, Katharine A.

doi:10.1513/annalsats.202105-591ed

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…From a health services perspective, predicting the need for high-intensity care is important. However, previous studies using expert-determined medication dosing and CIWA-Ar scores to define SAWS do not perform well in identifying individuals who progress to high-intensity care ( 1 , 16 , 25 ). In a data-driven manner, our results showed that medication doses and CIWA-Ar scores have high specificity but very poor sensitivity when used for predicting higher-intensity care.…”

Section: Discussionmentioning

confidence: 94%

Alcohol Withdrawal Severity Measures for Identifying Patients Requiring High-Intensity Care

To,

Steel,

Carey

et al. 2024

Critical Care Explorations

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OBJECTIVES: Alcohol withdrawal syndrome (AWS) may progress to require high-intensity care. Approaches to identify hospitalized patients with AWS who received higher level of care have not been previously examined. This study aimed to examine the utility of Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-Ar) for alcohol scale scores and medication doses for alcohol withdrawal management in identifying patients who received high-intensity care. DESIGN: A multicenter observational cohort study of hospitalized adults with alcohol withdrawal. SETTING: University of Chicago Medical Center and University of Wisconsin Hospital. PATIENTS: Inpatient encounters between November 2008 and February 2022 with a CIWA-Ar score greater than 0 and benzodiazepine or barbiturate administered within the first 24 hours. The primary composite outcome was patients who progressed to high-intensity care (intermediate care or ICU). INTERVENTIONS: None. MAIN RESULTS: Among the 8742 patients included in the study, 37.5% (n = 3280) progressed to high-intensity care. The odds ratio for the composite outcome increased above 1.0 when the CIWA-Ar score was 24. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at this threshold were 0.12 (95% CI, 0.11–0.13), 0.95 (95% CI, 0.94–0.95), 0.58 (95% CI, 0.54–0.61), and 0.64 (95% CI, 0.63–0.65), respectively. The OR increased above 1.0 at a 24-hour lorazepam milligram equivalent dose cutoff of 15 mg. The sensitivity, specificity, PPV, and NPV at this threshold were 0.16 (95% CI, 0.14–0.17), 0.96 (95% CI, 0.95–0.96), 0.68 (95% CI, 0.65–0.72), and 0.65 (95% CI, 0.64–0.66), respectively. CONCLUSIONS: Neither CIWA-Ar scores nor medication dose cutoff points were effective measures for identifying patients with alcohol withdrawal who received high-intensity care. Research studies for examining outcomes in patients who deteriorate with AWS will require better methods for cohort identification.

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Section: Discussionmentioning

confidence: 94%

Alcohol Withdrawal Severity Measures for Identifying Patients Requiring High-Intensity Care

To,

Steel,

Carey

et al. 2024

Critical Care Explorations

Self Cite

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“…It is generally recommended that long‐acting benzodiazepines (such as clozapine or diazepam) are superior to short‐acting benzodiazepines (such as alprazolam or lorazepam); AWS patients with mild symptoms and no risk of deterioration can be treated by adjuvant or monotherapy of benzodiazepines, gabapentin, or carbamazepine [91]. Phenobarbital may be a feasible alternative to benzodiazepines [64]. In fact, sedation is generally beneficial in the treatment of alcohol withdrawal.…”

Section: Alcohol Withdrawalmentioning

confidence: 99%

“…It has also been reported that excessive sweating and high fever associated with AWS can lead to hypotension and acute renal failure [63]. AWS is prevalent among hospitalized patients and those in intensive care units [64]. It comprises a continuum of neurophysiological signs and symptoms associated with the severity of the original AUDs [65,66] and can be fatal if individualized treatment is not provided [54,67,68].…”

Section: Alcohol Withdrawal Syndromementioning

confidence: 99%

From consumption to withdrawal: A broad synopsis of the effects of alcohol

Zhu,

Liu,

Kong

et al. 2023

Medicine Advances

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The consumption of alcohol reflects both societal norms and personal choices and has major clinical implications. Long‐term excess alcohol consumption leads to a domino effect of pathological outcomes and onset of chronic illness. However, the risks of alcohol consumption extend beyond long‐term health issues. Because habitual alcohol drinkers reach a state of systemic homeostasis, when they attempt withdrawal, they experience many negative physiological effects and may develop alcohol withdrawal syndrome. The complex interplay between alcohol consumption and withdrawal does not result solely in behavioral issues. Rather, a substantial number of important physiological adaptations and potential problems underly habitual drinking. Addressing these issues requires comprehensive medical observation and intervention. Here, we summarize the pathophysiological mechanisms, clinical diseases, and related treatment methods of alcohol consumption and withdrawal. The aim was to provide a reference to improve understanding of alcohol use and promote an informed approach to alcohol withdrawal.

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Improving Care for Inpatient Alcohol Withdrawal Syndrome: Addressing the Lack of Rigorous Research on a Common Condition

Cited by 2 publications

References 19 publications

Alcohol Withdrawal Severity Measures for Identifying Patients Requiring High-Intensity Care

Alcohol Withdrawal Severity Measures for Identifying Patients Requiring High-Intensity Care

From consumption to withdrawal: A broad synopsis of the effects of alcohol

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