scholarly journals Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives

2020 ◽  
Vol Volume 12 ◽  
pp. 53-65
Author(s):  
Chelsea Wolf ◽  
Ashley Curry ◽  
Jacob Nacht ◽  
Scott A Simpson
Keyword(s):  
Emergency Department ◽  
Alcohol Withdrawal

scholarly journals LO028: Prospective validation of an iOS app to evaluate tremor in patients with alcohol withdrawal syndrome

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S39-S39 ◽  
Author(s):  
B. Borgundvaag ◽  
S.L. McLeod ◽  
T.E. Dear ◽  
S.M. Carver ◽  
N. Norouzi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Prospective Observational Study ◽  
Alcohol Withdrawal Syndrome ◽  
Research Assistant ◽  
Rater Agreement ◽  
Objective Indicator ◽  
Expert Assessments

Introduction: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom driven approach, whereby patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised; CIWA-Ar) and treated according to severity. Among the domains assessed by the CIWA-Ar, tremor is the most objective indicator of withdrawal severity, however, the ability of clinicians to reliably quantify tremor is highly dependent on experience. The objective of this study was to prospectively validate an objective, reliable tool to standardize and quantify the severity of alcohol withdrawal tremor using the built-in accelerometer of an iOS application. Methods: A prospective observational study of patients ≥18 years presenting to an academic emergency department in alcohol withdrawal was conducted from Oct 2014 to Aug 2015. Assessments were videotaped by a research assistant and subsequently reviewed by 3 clinical experts, blinded to the primary clinical assessment. Tremor severity was scored using the 8-point CIWA scale (0=no tremor, 7=severe tremor). Accelerometer derived results were compared to expert assessments of each video. Inter-rater agreement was estimated using Cohen’s kappa (k) statistic. Results: 76 patients with 78 tremor recordings were included. Accelerometer derived tremor scores matched exactly with expert assessor scores in 36 (46.2%) cases, within 1 point for 73 (93.6%) cases and differed by ≥ 2 points in 5 (6.4%) cases. The overall kappa for agreement within 1 point for tremor severity was ‘very good’ 0.92 (95% CI: 0.86, 0.99). Conclusion: iOS accelerometer based assessment of the tremor component of the CIWA-Ar score is reliable and has potential to more accurately assess the severity of patients in alcohol withdrawal. We anticipate this resource will be easily disseminated and will impact and improve the care of patients with alcohol withdrawal.

Incorporating phenobarbital into your symptom-based benzodiazepine alcohol withdrawal protocol in the emergency department

2018 ◽  
Vol 36 (11) ◽  
pp. 2120-2121
Author(s):  
Amelia C. Nelson ◽  
Kevin A. Kaucher ◽  
Jeffrey Sankoff ◽  
David Mintzer ◽  
Julie Taub ◽  
...  
Keyword(s):  
Emergency Department ◽  
Alcohol Withdrawal

Treatment of alcohol withdrawal syndrome in the emergency department: a rapid review

2021 ◽  
Author(s):  
Justin Jek-Kahn Koh ◽  
Madeline Malczewska ◽  
Mary M. Doyle-Waters ◽  
Jessica Moe
Keyword(s):  
Emergency Department ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Observational Studies ◽  
Grey Literature ◽  
Alcohol Withdrawal Syndrome ◽  
Rapid Review ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Outpatient Settings

Abstract Background Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). Many ED patients with alcohol use disorder will require management of alcohol withdrawal. ED clinicians are responsible for risk-stratifying these patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome specifically in the emergency department setting. Methods We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We also searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. Results We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. Conclusions Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings need to be evaluated in the ED setting before routine use.

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

2018 ◽  
pp. emermed-2017-206997 ◽  
Author(s):  
Muhammad Fahmi Ismail ◽  
Kieran Doherty ◽  
Paula Bradshaw ◽  
Iomhar O’Sullivan ◽  
Eugene M Cassidy
Keyword(s):  
Emergency Department ◽  
Cumulative Dose ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Clinical Decision ◽  
Short Stay ◽  
Decision Unit ◽  
Clinical Decision Unit ◽  
Oral Diazepam

IntroductionWe 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.MethodsIn 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.Results5% (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).ConclusionSTT 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.

Lorazepam Versus Diazepam in the Management of Emergency Department Patients With Alcohol Withdrawal

2020 ◽  
Vol 76 (6) ◽  
pp. 774-781
Author(s):  
Frank X. Scheuermeyer ◽  
Isabelle Miles ◽  
Daniel J. Lane ◽  
Brian Grunau ◽  
Eric Grafstein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Alcohol Withdrawal ◽  
Emergency Department Patients

scholarly journals Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Justin Jek-Kahn Koh ◽  
Madeline Malczewska ◽  
Mary M. Doyle ◽  
Jessica Moe
Keyword(s):  
Emergency Department ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Observational Studies ◽  
Alcohol Withdrawal Syndrome ◽  
Withdrawal Symptoms ◽  
Rapid Review ◽  
Controlled Trials ◽  
Seizure Recurrence ◽  
Outpatient Settings

Abstract Background Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED. Methods We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. Results We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. Conclusions Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.

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