Shang X Z, Ding M X, Lin G A, Wang C, Lin Z C, Hu D S, Li S, Meng J S, Xiao R
PLA Burn Center, the 990th Hospital of Joint Logistics Support Force, Zhumadian 463000, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2025 Jun 20;41(6):587-593. doi: 10.3760/cma.j.cn501225-20240604-00211.
To investigate the misdiagnosis causes and treatment strategies for burns combined with alcohol withdrawal syndrome (AWS). This study was a retrospective observational study. From January 2014 to December 2023, 334 male burn patients aged 29-90 (53±11) years and combined with alcohol dependence were admitted to the PLA Burn Center of the 990 Hospital of Joint Logistics Support Force. Patients were divided into AWS group (29 cases) and non-AWS group (305 cases) based on whether AWS developed or not. The misdiagnosis causes and treatment outcomes of AWS of patients in AWS group were analyzed. The total burn surface area, full-thickness burn area, burn index, hospitalization day, and mortality were compared between patients in the two groups. The 334 patients were further stratified by burn severity into mild-moderate burn patients (306 cases), severe burn patients (11 cases), and critically severe burn patients (17 cases), and the correlation between AWS incidence and burn severity in patients with burns combined with alcohol dependence was analyzed. The misdiagnosis causes of AWS in AWS group of patients were primarily insufficient clinician awareness of AWS (48.3%, 14/29) and then overlapping symptoms between AWS and burn-related complications, such as shock, electrolyte imbalance, stress-induced mental disorders, and epilepsy (51.7%, 15/29), which influenced judgement of the clinicians. After active treatment, the AWS symptoms alleviated obviously or disappeared in 27 patients, while 2 patients died of multiple organ failure. Compared with those in non-AWS group, the total burn surface area, full-thickness burn area, burn index, and hospitalization day of patients in AWS group were significantly increased (with values of -8.35, -6.98, -8.32, and -4.56, respectively, <0.05). The mortality of patients in AWS group was 6.9% (2/29), which was significantly higher than 0.7% (2/305) in non-AWS group (<0.05). The AWS incidences of patients with mild-moderate burn, severe burn, and critically severe burn were 4/306, 8/11, and 17/17, respectively, and the AWS incidences of burn patients combined with alcohol dependence had strongly positive correlation with burn severity (=0.87, <0.05). The AWS incidence in burn patients is low, and its incidence is closely correlated with burn severity, predominantly affecting males over 40 years old with prolonged alcohol use and severe burns. The AWS symptoms appear later and are easily masked by symptoms of burn complications, making it easy to misdiagnose or even miss the diagnosis. Therefore, clinicians should strengthen the screening of alcohol drinking history in male severe burn patients over 40 years old, and consult with physicians of relevant disciplines in a timely manner to ensure early diagnosis and intervention to reduce the risks of misdiagnosis or missed diagnosis and to improve prognosis.
探讨烧伤合并酒精戒断综合征（AWS）的误诊原因及治疗策略。本研究为回顾性观察性研究。2014年1月至2023年12月，990医院解放军烧伤中心收治334例年龄29 - 90（53±11）岁、合并酒精依赖的男性烧伤患者。根据是否发生AWS将患者分为AWS组（29例）和非AWS组（305例）。分析AWS组患者AWS的误诊原因及治疗效果。比较两组患者的烧伤总面积、Ⅲ度烧伤面积、烧伤指数、住院天数及死亡率。将334例患者按烧伤严重程度进一步分层为轻中度烧伤患者（306例）、重度烧伤患者（11例）和特重度烧伤患者（17例），分析合并酒精依赖的烧伤患者中AWS发生率与烧伤严重程度的相关性。AWS组患者AWS的误诊原因主要为临床医生对AWS认识不足（48.3%，14/29），其次为AWS与烧伤相关并发症如休克、电解质紊乱、应激性精神障碍及癫痫等症状重叠（51.7%，15/29），影响了临床医生的判断。积极治疗后，27例患者AWS症状明显缓解或消失，2例患者死于多器官功能衰竭。与非AWS组相比，AWS组患者的烧伤总面积、Ⅲ度烧伤面积、烧伤指数及住院天数均显著增加（分别为-8.35、-6.98、-8.32及-4.56，P<0.05）。AWS组患者死亡率为6.9%（2/29），显著高于非AWS组的0.7%（2/305）（P<0.05）。轻中度烧伤、重度烧伤及特重度烧伤患者的AWS发生率分别为4/306、8/11及17/17，合并酒精依赖的烧伤患者中AWS发生率与烧伤严重程度呈强正相关（r = =0.87，P<0.05）。烧伤患者中AWS发生率较低，其发生率与烧伤严重程度密切相关，主要影响40岁以上长期饮酒且烧伤严重的男性。AWS症状出现较晚，易被烧伤并发症症状掩盖，容易误诊甚至漏诊。因此，临床医生应加强对40岁以上男性重度烧伤患者饮酒史的筛查，并及时与相关学科医生会诊，确保早期诊断和干预，降低误诊或漏诊风险，改善预后。
