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急诊科中酒精相关诊断成年患者硫胺素处方率较低。

Low rates of thiamine prescribing in adult patients with alcohol-related diagnoses in the emergency department.

作者信息

Peck Nathan M, Bania Theodore C, Chu Jason

机构信息

Department of Emergency Medicine, Mount Sinai West Hospital, Mt Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA.

出版信息

Am J Drug Alcohol Abuse. 2021 Nov 2;47(6):704-710. doi: 10.1080/00952990.2021.1889575. Epub 2021 Mar 29.

Abstract

Alcohol use disorder (AUD) is associated with thiamine deficiency and Wernicke-Korsakoff Syndrome (WKS). Thiamine supplementation for the prevention of WKS in patients with suspected AUD in the Emergency Department (ED) is generally recommended. As alcohol-related diagnoses are frequent reasons for visits to EDs, ED thiamine prescribing practices are relevant to the overall management and prevention of WKS in patients with AUD. To determine the prescription rates of thiamine to patients with alcohol-related diagnoses in the ED. This was a retrospective chart review conducted at two New York City urban teaching hospitals from January 1 to December 31, 2017. All patients 18 years or older who were given an alcohol-related diagnosis (all F10 ICD-10-CM codes) upon disposition were included. Collected data included details of thiamine prescribing practices, patient demographics and patient disposition. A total of 7,529 patient visits with an alcohol-related diagnosis were identified. The overall median age of included patients was 44; 5747 (76.3%) patient visits were by men; 310 (4.1%) patient visits resulted in admission. Out of all patient visits, thiamine was ordered during 167 (2.2%) visits, with thiamine administered parenterally during 129 (77.2%) visits and orally in 38 (22.8%) visits. Out of patient visits specifically associated with an F10.2 (Alcohol Dependence) diagnosis, thiamine was ordered during 105 (17.8%) visits. We found a very low rate of thiamine prescribing during patient visits associated with alcohol-related diagnoses. This may be a missed opportunity to reduce morbidity and mortality among AUD ED patients.

摘要

酒精使用障碍(AUD)与硫胺素缺乏及韦尼克 - 科尔萨科夫综合征(WKS)相关。通常建议在急诊科(ED)对疑似AUD患者补充硫胺素以预防WKS。由于与酒精相关的诊断是患者前往急诊科就诊的常见原因,急诊科硫胺素的处方开具做法与AUD患者WKS的整体管理和预防相关。为确定急诊科对有酒精相关诊断患者的硫胺素处方率。这是一项于2017年1月1日至12月31日在纽约市两家城市教学医院进行的回顾性病历审查。纳入所有18岁及以上在出院时被给予酒精相关诊断(所有F10 ICD - 10 - CM编码)的患者。收集的数据包括硫胺素处方开具做法的细节、患者人口统计学信息和患者出院情况。共识别出7529次有酒精相关诊断的患者就诊。纳入患者的总体中位年龄为44岁;5747次(76.3%)患者就诊为男性;310次(4.1%)患者就诊导致住院。在所有患者就诊中,167次(2.2%)就诊时开具了硫胺素,其中129次(77.2%)就诊时经肠胃外给予硫胺素,38次(22.8%)就诊时口服给予硫胺素。在与F10.2(酒精依赖)诊断特别相关的患者就诊中,105次(17.8%)就诊时开具了硫胺素。我们发现与酒精相关诊断的患者就诊期间硫胺素处方率非常低。这可能是一个减少AUD急诊科患者发病率和死亡率的错失机会。

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