Wang Alex, Park Andrew, Albert Ralph, Barriga Alyssa, Goodrich Leigh, Nguyen Bao-Nhan, Knox Erin, Preda Adrian
Psychiatry and Neurology, University of California Irvine School of Medicine, Irvine, USA.
Psychiatry and Neurology, University of California Irvine Medical Center, Orange, USA.
Cureus. 2021 Jun 1;13(6):e15373. doi: 10.7759/cureus.15373. eCollection 2021 Jun.
In this report, we present a case series involving four patients placed on the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) protocol for alcohol or sedative-hypnotic withdrawal syndromes, who developed delirium on sustained or increasing symptom-triggered benzodiazepine dosages. In each of the four cases, delirium was not present on admission and resolved in the hospital itself with fixed benzodiazepine tapers. Cases were selected from an electronic medical record database of patients admitted to a United States-based university hospital and placed on CIWA-Ar between 2017 and 2018. This case series illustrates the major limitations of CIWA-Ar including its subjective nature, its susceptibility to inappropriate patient selection, and its requirement for providers to consider alternative etiologies to alcohol and benzodiazepine withdrawal syndromes. These cases demonstrate the necessity of considering other assessment and treatment options such as objective alcohol withdrawal scales, fixed benzodiazepine tapers, and even antiepileptics. An effective systems-based approach to overcoming these challenges may include setting time limits on CIWA-Ar orders within the electronic health record (EHR) system.
在本报告中，我们介绍了一个病例系列，涉及四名因酒精或镇静催眠药戒断综合征而采用酒精戒断临床研究所修订评估量表（CIWA-Ar）方案的患者，他们在持续或增加症状触发的苯二氮䓬剂量时出现了谵妄。在这四个病例中，入院时均未出现谵妄，且在医院内通过固定的苯二氮䓬逐渐减量方案得以缓解。这些病例是从一家美国大学医院收治的患者的电子病历数据库中选取的，这些患者在2017年至2018年期间采用了CIWA-Ar方案。这个病例系列说明了CIWA-Ar的主要局限性，包括其主观性、易导致不恰当的患者选择，以及要求医护人员考虑酒精和苯二氮䓬戒断综合征以外的其他病因。这些病例表明，有必要考虑其他评估和治疗选择，如客观的酒精戒断量表、固定的苯二氮䓬逐渐减量方案，甚至抗癫痫药物。一种基于系统的有效方法来克服这些挑战可能包括在电子健康记录（EHR）系统中对CIWA-Ar医嘱设置时间限制。
