a Center for Chemical Dependence , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA.
b Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
Subst Abus. 2017 Oct-Dec;38(4):394-400. doi: 10.1080/08897077.2017.1354119. Epub 2017 Jul 12.
The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms.
A 6-item withdrawal scale developed at another institution was piloted. Based on comparison with the CIWA-Ar, this was adapted into a 5-item scale named the Brief Alcohol Withdrawal Scale (BAWS). The BAWS was compared with the CIWA-Ar and a withdrawal protocol utilizing the BAWS was developed. The new protocol was implemented on an inpatient unit dedicated to treating substance withdrawal. Data was collected on the first 3 months of implementation and compared with the 3 months prior to that.
A BAWS score of 3 or more predicted CIWA-Ar score ≥8 with a sensitivity of 85.3% and specificity of 65.8%. The demographics of the patients in the 2 time periods were similar: the mean age was 45.9; 70.6% were male; 30.9% received concurrent treatment for opioid withdrawal; and 14.2% were receiving methadone maintenance. During the BAWS phase, patients received significantly less diazepam (mean dose 81.4 vs. 60.3 mg, P < .001). There was no significant difference in length of stay. No patients experienced a seizure, delirium, or required transfer to a higher level of care during any of the 664 admissions in either phase.
This simple protocol utilizing a 5-item withdrawal scale performed well in this setting. Its use in other settings, particularly with patients with concurrent medical illnesses or more severe withdrawal, needs to be explored further.
酒精戒断管理的标准是采用临床酒精戒断评估量表（CIWA-Ar）进行症状触发治疗。该 10 项问题量表的许多项目依赖于对戒断症状的主观评估，因此使用起来既耗时又繁琐。因此，人们对评估酒精戒断症状的更短、更客观的方法感兴趣。
在另一家机构开发的 6 项戒断量表进行了试点。基于与 CIWA-Ar 的比较，该量表被改编成 5 项量表，称为简短酒精戒断量表（BAWS）。BAWS 与 CIWA-Ar 进行了比较，并制定了使用 BAWS 的戒断方案。该新方案在专门用于治疗物质戒断的住院病房实施。在实施的头 3 个月收集了数据，并与之前的 3 个月进行了比较。
BAWS 评分≥3 预测 CIWA-Ar 评分≥8，敏感性为 85.3%，特异性为 65.8%。两个时间段患者的人口统计学特征相似：平均年龄为 45.9 岁；70.6%为男性；30.9%同时接受阿片类药物戒断治疗；14.2%接受美沙酮维持治疗。在 BAWS 阶段，患者接受的地西泮剂量明显减少（平均剂量 81.4 与 60.3mg，P<.001）。住院时间无显著差异。在任何阶段的 664 次入院中，均无患者出现癫痫发作、谵妄或需要转至更高级别护理。
这种利用 5 项戒断量表的简单方案在这种情况下表现良好。需要进一步探索其在其他环境中的应用，特别是在伴有合并症或更严重戒断的患者中。
