BCCancer Provincial (Pharmacy), 750-600 W Broadway, Vancouver, BC, Canada.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
CJEM. 2024 Jun;26(6):431-435. doi: 10.1007/s43678-024-00710-7. Epub 2024 May 26.
We evaluated impact on length of stay and possible complications of replacing the Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar) scale with a slightly modified Richmond Agitation and Sedation Scale (mRASS-AW) to support managing patients admitted with alcohol withdrawal symptoms in a community hospital. Since mRASS-AW is viewed as easier and quicker to use than CIWA-Ar, provided use of mRASS-AW does not worsen outcomes, it could be a safe alternative in a busy ED environment and offer an opportunity to release nursing time to care.
Retrospective time-series analysis of mean quarterly length of stay. All analyses exclusively used our hospital's administrative discharge diagnoses database. During April 1st 2012 to December 14th 2014, the CIWA-Ar was used in the ED and in-patient units to guide benzodiazepine dosing decisions for alcohol withdrawal symptoms. After this point, CIWA-Ar was replaced with mRASS-AW. Data was evaluated until December 31st 2020.
mean quarterly length of stay.
delirium, intensive care unit (ICU) admission, other post-admission complications, mortality.
N = 1073 patients. No association between length of stay and scale switch (slope change 0.3 (95% CI - 0.03 to 0.6), intercept change, 0.06 (- 0.03 to 0.2). CIWA-Ar (n = 317) mean quarterly length of stay, 5.7 days (95% 4.2-7.1), mRASS-AW (n = 756) 5.0 days (95% CI 4.3-5.6). Incidence of delirium, ICU admission or mortality was not different. However, incidence of other post-admission complications was higher with CIWA-Ar (6.6%) than mRASS-AW (3.4%) (p = 0.020).
This was the first study to compare patient outcomes associated with using mRASS-AW for alcohol withdrawal symptoms outside the ICU. Replacing CIWA-Ar with mRASS-AW did not worsen length of stay or complications. These findings provide some evidence that mRASS-AW could be considered an alternative to CIWA-Ar and potentially may provide an opportunity to release nursing time to care.
我们评估了用稍微修改的 Richmond 激越和镇静量表（mRASS-AW）替代临床戒断评估-酒精修订版（CIWA-Ar）量表对支持管理在社区医院接受酒精戒断症状的患者的住院时间和可能的并发症的影响。由于 mRASS-AW 被认为比 CIWA-Ar 更容易和更快使用，如果使用 mRASS-AW 不会恶化结果，那么它可能是一个繁忙的急诊环境中的安全替代方案，并为释放护理时间提供机会。
回顾性季度平均住院时间的时间序列分析。所有分析均仅使用我们医院的行政出院诊断数据库。在 2012 年 4 月 1 日至 2014 年 12 月 14 日期间，CIWA-Ar 用于急诊科和住院病房，以指导苯二氮䓬类药物治疗酒精戒断症状的剂量决策。此后，CIWA-Ar 被 mRASS-AW 取代。数据评估直至 2020 年 12 月 31 日。
季度平均住院时间。
谵妄、重症监护病房（ICU）入院、其他入院后并发症、死亡率。
共纳入 1073 例患者。住院时间与量表转换之间没有关联（斜率变化 0.3（95%CI-0.03 至 0.6），截距变化 0.06（-0.03 至 0.2）。CIWA-Ar（n=317）季度平均住院时间为 5.7 天（95%CI4.2-7.1），mRASS-AW（n=756）为 5.0 天（95%CI4.3-5.6）。谵妄、ICU 入院或死亡率无差异。然而，CIWA-Ar（6.6%）的其他入院后并发症发生率高于 mRASS-AW（3.4%）（p=0.020）。
这是第一项比较使用 mRASS-AW 治疗 ICU 外酒精戒断症状的患者结局的研究。用 mRASS-AW 替代 CIWA-Ar 不会延长住院时间或增加并发症。这些发现为 mRASS-AW 可作为 CIWA-Ar 的替代方案，并可能为释放护理时间提供机会提供了一些证据。
