Marchand Tiffany D, Dunham C Michael, Chance Elisha A, Hileman Barbara M
Trauma, Critical Care, and General Surgery Services, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States.
Trauma, Critical Care, and General Surgery Services, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States.
Injury. 2023 Jan;54(1):198-206. doi: 10.1016/j.injury.2022.08.072. Epub 2022 Sep 3.
Because the proportion of trauma patients developing alcohol withdrawal syndrome (AWS) is low, AWS risk conditions have not been precisely delineated. We aimed to create multifactor screening strategies to assess probabilities for the likelihood of developing AWS.
We performed a retrospective chart review of 1,011 trauma patients admitted to a Level I trauma center to investigate the associations between AWS and probable AWS risk conditions. Included patients were adults who met trauma registry inclusion criteria and had blood alcohol concentration (BAC) testing performed. Patients were excluded if they had a traumatic brain injury with a Glasgow Coma Score (GCS) ≤ 8, or no BAC testing performed. We defined heavy drinking as daily drinking or >7 per week.
AWS had univariate associations with heavy drinking history, Injury Severity Score (ISS) ≥15, psychiatric disorders, liver disease, smoking history, in-hospital bronchodilator administration, age ≥45, male sex, Intensive Care Unit (ICU) admission, serum aspartate aminotransferase (AST) ≥40 U/L, and cognitive preservation (GCS ≥13 with BAC ≥100 mg/dL) (all, p < 0.05). ICU admission, AST ≥40 U/L, cognitive preservation, male sex, and age ≥45 had associations with ISS ≥15 or alcohol misuse (all, p < 0.0001). For patients with age ≥45 and heavy drinking history or age <45 and heavy drinking history with ISS ≥15 and ICU admission, the AWS proportion (15.3%) was greater in comparison to other patients (0.3%). The AWS risk score was the sum of the following nine conditions, assigned a zero when the condition was absent and one when present (range 0-9): ISS ≥15, psychiatric disorders, liver disease, smoking history, in-hospital bronchodilator administration, age ≥45, male sex, AST ≥40 U/L, and cognitive preservation. The AWS proportion was greater with a risk score of 5-9 (16.8%) than of 0-4 (1.2%; p < 0.0001).
AWS in the setting of traumatic injury is associated with multiple risk conditions. The presence of multiple risk conditions might have additive effects that could contribute toward a clinical manifestation of AWS. The identified risk conditions may be associated with a hyperadrenergic state.
由于发生酒精戒断综合征（AWS）的创伤患者比例较低，AWS的风险条件尚未得到精确界定。我们旨在创建多因素筛查策略，以评估发生AWS的可能性。
我们对一家一级创伤中心收治的1011例创伤患者进行了回顾性病历审查，以调查AWS与可能的AWS风险条件之间的关联。纳入的患者为符合创伤登记纳入标准且进行了血液酒精浓度（BAC）检测的成年人。如果患者患有格拉斯哥昏迷评分（GCS）≤8的创伤性脑损伤或未进行BAC检测，则将其排除。我们将大量饮酒定义为每日饮酒或每周饮酒超过7次。
AWS与大量饮酒史、损伤严重程度评分（ISS）≥15、精神疾病、肝病、吸烟史、住院期间使用支气管扩张剂、年龄≥45岁、男性、入住重症监护病房（ICU）、血清天冬氨酸转氨酶（AST）≥40 U/L以及认知保留（GCS≥13且BAC≥100 mg/dL）均存在单因素关联（所有p<0.05）。入住ICU、AST≥40 U/L、认知保留、男性以及年龄≥45岁与ISS≥15或酒精滥用均存在关联（所有p<0.0001）。对于年龄≥45岁且有大量饮酒史或年龄<45岁且有大量饮酒史、ISS≥15且入住ICU的患者，AWS比例（15.3%）高于其他患者（0.3%）。AWS风险评分是以下九个条件的总和，条件不存在时赋值为0，存在时赋值为1（范围0-9）：ISS≥15、精神疾病、肝病、吸烟史、住院期间使用支气管扩张剂、年龄≥45岁、男性、AST≥40 U/L以及认知保留。风险评分为5-9时的AWS比例（16.8%）高于0-4时（1.2%；p<0.0001）。
创伤情况下的AWS与多种风险条件相关。多种风险条件的存在可能具有累加效应，这可能导致AWS的临床表现。所确定的风险条件可能与高肾上腺素能状态相关。
