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.authorIsmail, Muhammad Fahmi
dc.contributor.authorDoherty, Kieran
dc.contributor.authorBradshaw, Paula
dc.contributor.authorO'Sullivan, Iomhar
dc.contributor.authorCassidy, Eugene M.
dc.date.accessioned2018-12-06T09:41:54Z
dc.date.available2018-12-06T09:41:54Z
dc.date.issued2018-10-03
dc.description.abstractIntroduction: 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.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationIsmail, 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-2017-206997en
dc.identifier.doi10.1136/emermed-2017-206997
dc.identifier.endpage4en
dc.identifier.issn1472-0205
dc.identifier.issn1472-0213
dc.identifier.journaltitleEmergency Medicine Journalen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/7175
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttp://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.subjectAlcohol withdrawalen
dc.subjectAlcoholen
dc.subjectSymptom-triggered therapy (STT)en
dc.subjectBenzodiazepine detoxificationen
dc.subjectBenzodiazepinesen
dc.subjectEmergency department (ED)en
dc.subjectSubstance abuseen
dc.titleSymptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision uniten
dc.typeArticle (peer-reviewed)en
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