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NEW YORK – The Clinical Institute Withdrawal Assessment of Alcohol score proved to be the most reliable predictor of complications in hospitalized alcohol withdrawal patients, reported Dr. Austin S. Lin in a poster at the annual meeting of the American Psychiatric Association.
Dr. Lin of the Veterans Affairs Boston Healthcare System and Harvard Medical School, also in Boston, and his colleagues conducted a retrospective chart review of 47 veterans (mean age, 53 years; 100% male) consecutively admitted to a single center for alcohol withdrawal in April 2013.
Overall, 10 patients (21%) developed complications during withdrawal treatment. Complications included the use of chemical and physical restraints (10.6%), the use of a sitter (12.8%), new onset delirium tremens (6.4%), or the calling of security in a "code green" situation, which signifies a psychiatric emergency (4.3%).
The authors found that a baseline CIWA (Clinical Institute Withdrawal Assessment) score of 15 or greater significantly increased the odds of any of these complications (50% vs. 3.5%, P = .005), and was therefore their single best predictor, more so than demographics, admission blood alcohol level, Charlson comorbidity index (CCI), and drinks per drinking day.
Indeed, neither homelessness, nor a history of blackouts, nor even a history of alcohol-related seizures was a better predictor, a finding that Dr. Lin called "surprising" in an interview.
On the other hand, a history of delirium tremens and a baseline pulse on admission greater than 100 bpm both seemed to carry slightly higher risks of complications, which trended toward significance. Similarly, patients who received benzodiazepines prior to specialist consultation had more complications than those who underwent the consult first, though this did not reach significance, either (80% vs. 46%, P = .08).
The authors conceded that their study was limited by a small sample size. Also, the study cohort was Veterans Affairs–based, which means that the results might not be generalizable to other populations. Moreover, the outcomes for patients who receive no specialist consultation at all are not assessed in this study.
Additionally, study subjects underwent multiple methods of detoxification, including symptom-triggered and fixed-dosing methods.
In any case, "This study demonstrates that if CIWA can be used to score a patient’s level of withdrawal appropriately, it can be a very useful tool in helping a provider appropriately triage," Dr. Lin wrote. "It can also alert [providers] ... to get the consult-liaison psychiatry team involved at an earlier stage."
Future studies might focus on whether higher CIWA scores translated to ICU admissions, vs. noncritical care floors and on the extent to which such a setting might affect complication rates as well as lengths of stay, he added.
Dr. Lin wrote that neither he nor his colleagues had any disclosures relevant to this study.
There are approximately 500,000 cases of alcohol withdrawal that require pharmacologic intervention each year in the United States. Identifying these cases can be difficult as patients often do not report or underreport their alcohol intake (N. Engl. J. Med. 2003;348:1786). There is a spectrum of alcohol-withdrawal presentations, ranging from mild withdrawal symptoms to delirium tremens (DTs). The mortality rate associated with DTs can approach 5%.
It is important to identify those patients at risk for developing alcohol withdrawal syndrome. Dr. Lin's poster presentation is a step toward providing a means of predicting those at risk for complications associated with alcohol withdrawal syndrome. These complications can range from chemical or physical restraints to use of security to assist with managing the patient to DTs. The poster relied on the use the Clinical Institute Withdrawal Assessment (CIWA) scoring system. The CIWA score has become a helpful tool for hospitalists in managing patients withdrawing from alcohol, particularly when using symptom-triggered dosing for benzodiazepines (BZDs).
Dr. Lin's group reviewed the charts of 47 consecutive veterans admitted for alcohol withdrawal. They identified that a baseline CIWA score of 15 or greater identified patients at significantly increased risk of complications (50% vs. 3.5%; P = .005). This score proved to be a better predictor than a number of other scores, levels, or patient characteristics.
The authors acknowledged the limitations in their study - small sample size, limited (in other words, veterans) population and mixed means of detoxification. However, this study provides an early platform for further research into appropriate triage of patients with alcohol withdrawal syndrome and may allow for earlier intervention in patients identified as high risk.
Dr. Michael Pistoria is chief of hospital medicine at coordinated health in Lehigh Valley, Pa., and an adviser to Hospitalist News.
There are approximately 500,000 cases of alcohol withdrawal that require pharmacologic intervention each year in the United States. Identifying these cases can be difficult as patients often do not report or underreport their alcohol intake (N. Engl. J. Med. 2003;348:1786). There is a spectrum of alcohol-withdrawal presentations, ranging from mild withdrawal symptoms to delirium tremens (DTs). The mortality rate associated with DTs can approach 5%.
It is important to identify those patients at risk for developing alcohol withdrawal syndrome. Dr. Lin's poster presentation is a step toward providing a means of predicting those at risk for complications associated with alcohol withdrawal syndrome. These complications can range from chemical or physical restraints to use of security to assist with managing the patient to DTs. The poster relied on the use the Clinical Institute Withdrawal Assessment (CIWA) scoring system. The CIWA score has become a helpful tool for hospitalists in managing patients withdrawing from alcohol, particularly when using symptom-triggered dosing for benzodiazepines (BZDs).
Dr. Lin's group reviewed the charts of 47 consecutive veterans admitted for alcohol withdrawal. They identified that a baseline CIWA score of 15 or greater identified patients at significantly increased risk of complications (50% vs. 3.5%; P = .005). This score proved to be a better predictor than a number of other scores, levels, or patient characteristics.
The authors acknowledged the limitations in their study - small sample size, limited (in other words, veterans) population and mixed means of detoxification. However, this study provides an early platform for further research into appropriate triage of patients with alcohol withdrawal syndrome and may allow for earlier intervention in patients identified as high risk.
Dr. Michael Pistoria is chief of hospital medicine at coordinated health in Lehigh Valley, Pa., and an adviser to Hospitalist News.
There are approximately 500,000 cases of alcohol withdrawal that require pharmacologic intervention each year in the United States. Identifying these cases can be difficult as patients often do not report or underreport their alcohol intake (N. Engl. J. Med. 2003;348:1786). There is a spectrum of alcohol-withdrawal presentations, ranging from mild withdrawal symptoms to delirium tremens (DTs). The mortality rate associated with DTs can approach 5%.
It is important to identify those patients at risk for developing alcohol withdrawal syndrome. Dr. Lin's poster presentation is a step toward providing a means of predicting those at risk for complications associated with alcohol withdrawal syndrome. These complications can range from chemical or physical restraints to use of security to assist with managing the patient to DTs. The poster relied on the use the Clinical Institute Withdrawal Assessment (CIWA) scoring system. The CIWA score has become a helpful tool for hospitalists in managing patients withdrawing from alcohol, particularly when using symptom-triggered dosing for benzodiazepines (BZDs).
Dr. Lin's group reviewed the charts of 47 consecutive veterans admitted for alcohol withdrawal. They identified that a baseline CIWA score of 15 or greater identified patients at significantly increased risk of complications (50% vs. 3.5%; P = .005). This score proved to be a better predictor than a number of other scores, levels, or patient characteristics.
The authors acknowledged the limitations in their study - small sample size, limited (in other words, veterans) population and mixed means of detoxification. However, this study provides an early platform for further research into appropriate triage of patients with alcohol withdrawal syndrome and may allow for earlier intervention in patients identified as high risk.
Dr. Michael Pistoria is chief of hospital medicine at coordinated health in Lehigh Valley, Pa., and an adviser to Hospitalist News.
NEW YORK – The Clinical Institute Withdrawal Assessment of Alcohol score proved to be the most reliable predictor of complications in hospitalized alcohol withdrawal patients, reported Dr. Austin S. Lin in a poster at the annual meeting of the American Psychiatric Association.
Dr. Lin of the Veterans Affairs Boston Healthcare System and Harvard Medical School, also in Boston, and his colleagues conducted a retrospective chart review of 47 veterans (mean age, 53 years; 100% male) consecutively admitted to a single center for alcohol withdrawal in April 2013.
Overall, 10 patients (21%) developed complications during withdrawal treatment. Complications included the use of chemical and physical restraints (10.6%), the use of a sitter (12.8%), new onset delirium tremens (6.4%), or the calling of security in a "code green" situation, which signifies a psychiatric emergency (4.3%).
The authors found that a baseline CIWA (Clinical Institute Withdrawal Assessment) score of 15 or greater significantly increased the odds of any of these complications (50% vs. 3.5%, P = .005), and was therefore their single best predictor, more so than demographics, admission blood alcohol level, Charlson comorbidity index (CCI), and drinks per drinking day.
Indeed, neither homelessness, nor a history of blackouts, nor even a history of alcohol-related seizures was a better predictor, a finding that Dr. Lin called "surprising" in an interview.
On the other hand, a history of delirium tremens and a baseline pulse on admission greater than 100 bpm both seemed to carry slightly higher risks of complications, which trended toward significance. Similarly, patients who received benzodiazepines prior to specialist consultation had more complications than those who underwent the consult first, though this did not reach significance, either (80% vs. 46%, P = .08).
The authors conceded that their study was limited by a small sample size. Also, the study cohort was Veterans Affairs–based, which means that the results might not be generalizable to other populations. Moreover, the outcomes for patients who receive no specialist consultation at all are not assessed in this study.
Additionally, study subjects underwent multiple methods of detoxification, including symptom-triggered and fixed-dosing methods.
In any case, "This study demonstrates that if CIWA can be used to score a patient’s level of withdrawal appropriately, it can be a very useful tool in helping a provider appropriately triage," Dr. Lin wrote. "It can also alert [providers] ... to get the consult-liaison psychiatry team involved at an earlier stage."
Future studies might focus on whether higher CIWA scores translated to ICU admissions, vs. noncritical care floors and on the extent to which such a setting might affect complication rates as well as lengths of stay, he added.
Dr. Lin wrote that neither he nor his colleagues had any disclosures relevant to this study.
NEW YORK – The Clinical Institute Withdrawal Assessment of Alcohol score proved to be the most reliable predictor of complications in hospitalized alcohol withdrawal patients, reported Dr. Austin S. Lin in a poster at the annual meeting of the American Psychiatric Association.
Dr. Lin of the Veterans Affairs Boston Healthcare System and Harvard Medical School, also in Boston, and his colleagues conducted a retrospective chart review of 47 veterans (mean age, 53 years; 100% male) consecutively admitted to a single center for alcohol withdrawal in April 2013.
Overall, 10 patients (21%) developed complications during withdrawal treatment. Complications included the use of chemical and physical restraints (10.6%), the use of a sitter (12.8%), new onset delirium tremens (6.4%), or the calling of security in a "code green" situation, which signifies a psychiatric emergency (4.3%).
The authors found that a baseline CIWA (Clinical Institute Withdrawal Assessment) score of 15 or greater significantly increased the odds of any of these complications (50% vs. 3.5%, P = .005), and was therefore their single best predictor, more so than demographics, admission blood alcohol level, Charlson comorbidity index (CCI), and drinks per drinking day.
Indeed, neither homelessness, nor a history of blackouts, nor even a history of alcohol-related seizures was a better predictor, a finding that Dr. Lin called "surprising" in an interview.
On the other hand, a history of delirium tremens and a baseline pulse on admission greater than 100 bpm both seemed to carry slightly higher risks of complications, which trended toward significance. Similarly, patients who received benzodiazepines prior to specialist consultation had more complications than those who underwent the consult first, though this did not reach significance, either (80% vs. 46%, P = .08).
The authors conceded that their study was limited by a small sample size. Also, the study cohort was Veterans Affairs–based, which means that the results might not be generalizable to other populations. Moreover, the outcomes for patients who receive no specialist consultation at all are not assessed in this study.
Additionally, study subjects underwent multiple methods of detoxification, including symptom-triggered and fixed-dosing methods.
In any case, "This study demonstrates that if CIWA can be used to score a patient’s level of withdrawal appropriately, it can be a very useful tool in helping a provider appropriately triage," Dr. Lin wrote. "It can also alert [providers] ... to get the consult-liaison psychiatry team involved at an earlier stage."
Future studies might focus on whether higher CIWA scores translated to ICU admissions, vs. noncritical care floors and on the extent to which such a setting might affect complication rates as well as lengths of stay, he added.
Dr. Lin wrote that neither he nor his colleagues had any disclosures relevant to this study.
AT THE APA ANNUAL MEETING
Key clinical point: Scores on the CIWA might be a better predictor of complications from withdrawal than homelessness, a history of blackouts, or alcohol-related seizures.
Major finding: A baseline CIWA score of 15 or greater significantly increased the odds of complications during alcohol withdrawal (50% vs. 3.5%, P=0.005).
Data source: A chart review of 47 veterans consecutively admitted to a single center for alcohol withdrawal in April 2013.
Disclosures: Dr. Lin wrote that neither he nor his colleagues had any disclosures relevant to this study.