Cooper Medical School of Rowan University, United States of America.
Cooper Medical School of Rowan University, United States of America; Cooper Research Institute, United States of America.
J Subst Use Addict Treat. 2024 Sep;164:209443. doi: 10.1016/j.josat.2024.209443. Epub 2024 Jun 12.
Alcohol Withdrawal Syndrome (AWS) is a potentially life-threatening complication of alcohol use disorder (AUD) that can be challenging to recognize in hospitalized patients. Our institution implemented universal AUD screening for all patients admitted to a non-critical care venue using the Prediction of Alcohol Withdrawal Severity Scale (PAWSS). At risk patients were then further assessed, utilizing the Glasgow Modified Alcohol Withdrawal Scale (GMAWS), and medicated according to a predetermined protocol. This study sought to determine whether this protocol decreased hospital length of stay, lowered the total benzodiazepine dose administered, and decreased adverse events attributable to AWS.
This retrospective cohort study was conducted over a 6-year period from 2014 to 2020. The study included patients with an ICD-10 code diagnosis of AWS and subsequently divided them into two groups: pre- and post-protocol introduction. Outcome measures were compared pre- versus post-protocol introduction.
There were 181 patient encounters pre- and 265 patient encounters post-protocol. There was no statistically significant difference in median length of stay between the two groups (2.956 days pre and 3.250 days post-protocol, p = 0.058). Post-protocol, there was a statistically significant reduction in median total benzodiazepine dose (13.5 mg and 9 mg lorazepam equivalents pre- and post-protocol, p < 0.001) and in occurrence of delirium tremens (7.7 % pre and 2.3 % post-protocol, p = 0.006).
Protocol implementation did not reduce length of stay in patients with AUD but was associated with a significant reduction in total benzodiazepine dose and, when adjusted, a non-statistically significant decrease in progression to delirium tremens in hospitalized patients, after applying Bonferroni adjustment.
酒精戒断综合征（AWS）是酒精使用障碍（AUD）的一种潜在危及生命的并发症，在住院患者中可能难以识别。我们的机构对所有收入非重症监护病房的患者使用酒精戒断严重程度预测量表（PAWSS）进行了普遍的 AUD 筛查。有风险的患者随后使用格拉斯哥改良酒精戒断量表（GMAWS）进行进一步评估，并根据预定方案进行药物治疗。本研究旨在确定该方案是否缩短了住院时间、降低了所用苯二氮䓬类药物的总剂量，并减少了 AWS 相关的不良事件。
这是一项回顾性队列研究，在 2014 年至 2020 年的 6 年期间进行。研究包括 ICD-10 编码诊断为 AWS 的患者，随后将他们分为两组：方案引入前和引入后。比较了方案引入前后的结果。
方案引入前有 181 例患者，方案引入后有 265 例患者。两组的中位住院时间无统计学差异（方案引入前 2.956 天，方案引入后 3.250 天，p=0.058）。方案引入后，中位总苯二氮䓬类药物剂量（13.5mg 和 9mg 劳拉西泮等效物，方案引入前和后，p<0.001）和震颤谵妄的发生率（7.7%和 2.3%，p=0.006）均有统计学显著降低。
方案实施并未缩短 AUD 患者的住院时间，但与苯二氮䓬类药物总剂量的显著减少相关，并且在应用 Bonferroni 校正后，与住院患者震颤谵妄进展的非统计学显著减少相关。
