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

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dc.contributor.author Ismail, Muhammad Fahmi
dc.contributor.author Doherty, Kieran
dc.contributor.author Bradshaw, Paula
dc.contributor.author O'Sullivan, Iomhar
dc.contributor.author Cassidy, Eugene M.
dc.date.accessioned 2018-12-06T09:41:54Z
dc.date.available 2018-12-06T09:41:54Z
dc.date.issued 2018-10-03
dc.identifier.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 en
dc.identifier.startpage 1 en
dc.identifier.endpage 4 en
dc.identifier.issn 1472-0205
dc.identifier.issn 1472-0213
dc.identifier.uri http://hdl.handle.net/10468/7175
dc.identifier.doi 10.1136/emermed-2017-206997
dc.description.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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group en
dc.relation.uri http://dx.doi.org/10.1136/emermed-2017-206997
dc.rights © Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ. en
dc.subject Alcohol withdrawal en
dc.subject Alcohol en
dc.subject Symptom-triggered therapy (STT) en
dc.subject Benzodiazepine detoxification en
dc.subject Benzodiazepines en
dc.subject Emergency department (ED) en
dc.subject Substance abuse en
dc.title Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Eugene Cassidy, Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland. T: +353-21-490-3000 E: eugene.cassidy@hse.ie en
dc.internal.availability Full text available en
dc.description.version Accepted Version en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Emergency Medicine Journal en
dc.internal.bibliocheck E Pub before print, Dec 2018. Update citation details, add volume, start page, endpage en


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