Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit

Ismail, Muhammad Fahmi; Doherty, Kieran; Bradshaw, Paula; O'Sullivan, Iomhar; Cassidy, Eugene M.

Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit

Files

8140_STT-EMJ-manuscript-accepted.pdf(616.67 KB)

Accepted version

Date

2018-10-03

Authors

Ismail, Muhammad Fahmi

Doherty, Kieran

Bradshaw, Paula

O'Sullivan, Iomhar

Cassidy, Eugene M.

Publisher

BMJ Publishing Group

Published Version

10.1136/emermed-2017-206997

Abstract

Introduction: We previously reported that benzodiazepine detoxification for alcohol withdrawal using symptom-triggered therapy (STT) with oral diazepam reduced length of stay (LOS) and cumulative benzodiazepine dose by comparison with standard fixed-dose regimen. In this study, we aim to describe the feasibility of STT in an emergency department (ED) short-stay clinical decision unit (CDU) setting. Methods In this retrospective cohort study, we describe our experience with STT over a full calendar year (2014) in the CDU. A retrospective chart review was conducted and data collection included demographics, clinical details, total cumulative dose of diazepam, receipt of parenteral thiamine, LOS and disposition. Results: 5% (n=174) of 3222 admissions to CDU required STT. Collapse or seizure (41%, n=71) and alcohol withdrawal (21%, n=37) were the most common reasons recorded for admission to CDU in those who required STT. Median Alcohol Use Disorders Identification Test score was 25 and 112 patients (64%) had at least one Clinical Institute Withdrawal Assessment for Alcohol revised measurement ≥10, triggering a dose of diazepam (20 mg). The median cumulative oral diazepam dose was 20 mg while 24 (15%) patients received a cumulative dose of 100 mg or more. Median time for STT was 12 hours (IQR=12, R=1–48). 3% (n=5) of patients required further general hospital admission and median LOS in CDU, was 22 hours (IQR=20, R=1–168). Conclusion: STT is potentially feasible as a rapid and effective approach to managing alcohol withdrawal syndrome in the ED/CDU short-stay inpatient setting where patient LOS is generally less than 24 hours.

Keywords

Alcohol withdrawal , Alcohol , Symptom-triggered therapy (STT) , Benzodiazepine detoxification , Benzodiazepines , Emergency department (ED) , Substance abuse

Citation

Ismail, M. F., Doherty, K., Bradshaw, P., O’Sullivan, I. and Cassidy, E. M. (2018) 'Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit', Emergency Medicine Journal, Epub ahead of print, doi: 10.1136/emermed-2017-206997