Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study

被引：1

作者：

Ronan, Matthew V. ^{[1
,2
]}

Gordon, Kirsha S. ^{[3
,4
]}

Skanderson, Melissa ^{[3
]}

Krug, Michael ^{[5
,6
]}

Godwin, Patrick ^{[7
,8
]}

Heppe, Daniel ^{[9
,10
]}

Hoegh, Matthew ^{[9
,10
]}

Boggan, Joel C. ^{[11
,12
]}

Gutierrez, Jeydith ^{[13
,14
]}

Kaboli, Peter ^{[13
,14
]}

Pescetto, Micah ^{[15
]}

Guidry, Michelle ^{[16
,17
]}

Caldwell, Peter ^{[16
,17
]}

Mitchell, Christine ^{[18
]}

Ehlers, Erik ^{[18
,19
]}

Allaudeen, Nazima ^{[20
,21
]}

Cyr, Jessica ^{[22
,23
]}

Smeraglio, Andrea ^{[24
,25
]}

Yarbrough, Peter ^{[26
,27
]}

Rose, Richard ^{[26
,27
]}

Jagannath, Anand ^{[24
,25
]}

Vargas, Jaclyn ^{[28
]}

Cornia, Paul B. ^{[6
,29
]}

Shah, Meghna ^{[6
,29
]}

Tuck, Matthew ^{[30
]}

Arundel, Cherinne ^{[30
,32
]}

Laudate, James ^{[33
,34
]}

Elzweig, Joel ^{[33
,34
]}

Rodwin, Benjamin ^{[3
,4
]}

Akwe, Joyce ^{[35
,36
]}

Trubitt, Meredith ^{[31
,35
,36
]}

Gunderson, Craig G. ^{[3
,4
]}

机构：

[1] VA Boston Healthcare Syst, Med Serv, GIM Sect, 1400 VFW Parkway, West Roxbury, MA 02132, Brazil

[2] Harvard Med Sch, Boston, MA USA

[3] VAConnecticut Healthcare Syst, West Haven, CT USA

[4] Yale Univ, Sch Med, New Haven, CT USA

[5] Boise VA Med Ctr, Med Serv, Boise, ID USA

[6] Univ Washington, Sch Med, Seattle, WA USA

[7] Jesse Brown VA Med Ctr, Med Serv, Chicago, IL USA

[8] Univ Illinois, Coll Med, Chicago, IL USA

[9] VAEastern Colorado Hlth Care Syst, Aurora, CO USA

[10] Univ Colorado, Sch Med, Dept Med, Aurora, CO USA

[11] Durham VA Med Ctr, Med Serv, Durham, NC USA

[12] Duke Univ, Sch Med, Dept Med, Durham, NC USA

[13] Iowa City VA Healthcare Syst, Sect Hosp Med, Iowa City, IA USA

[14] Univ Iowa HealthCare, Carver Coll Med, Dept Med, Iowa City, IA USA

[15] VA Kansas City Hlth Care, Med Serv, Kansas City, MO USA

[16] NewOrleans VA Med Ctr, Med Serv, New Orleans, LA USA

[17] Tulane Univ, Sch Med, New Orleans, LA USA

[18] Vet Affairs Nebraska Western Iowa Hlth Care Syst, Med Serv, Omaha, NE USA

[19] Univ Nebraska, Coll Med, Med Ctr, Omaha, NE USA

[20] VA Palo Alto Healthcare Syst, Med Serv, Palo Alto, CA USA

[21] Stanford Univ, Sch Med, Palo Alto, CA USA

[22] Pittsburgh VA Med Ctr, Med Serv, Pittsburgh, PA USA

[23] Pittsburgh Univ, Sch Med, Pittsburgh, PA USA

[24] VAPortland Healthcare Syst, Med Serv, Portland, OR USA

[25] Oregon Hlth & Sci Univ, Sch Med, Portland, OR USA

[26] Salt Lake City VA Med Ctr, Med Serv, Salt Lake City, UT USA

[27] Uniers Utah, Sch Med, Salt Lake City, UT USA

[28] San Diego VA Med Ctr, Med Serv, San Diego, CA USA

[29] VA Puget Sound Healthcare Syst, Med Serv, Seattle, WA USA

[30] VA Washington DC Hlth Care Syst, Med Serv, Washington, DC USA

[31] George Washington Univ, Sch Med & Hlth Sci, Washington, DC USA

[32] Georgetown Univ, Sch Med, Washington, DC USA

[33] White River Junct VA Med Ctr, Med Serv, White River Jct, VT USA

[34] Geisel Sch Med Dartmouth, Hanover, NH USA

[35] Atlanta VA Med Ctr, Med Serv, Atlanta, GA USA

[36] Emory Univ, Sch Med, Atlanta, GA USA

来源：

JOURNAL OF ADDICTION MEDICINE | 2024年 / 18卷 / 04期

关键词：

alcohol withdrawal; general medical wards; symptom-triggered treatment; long-acting benzodiazepines; DELIRIUM-TREMENS; PREDICTORS; PATIENT;

D O I：

10.1097/ADM.0000000000001297

中图分类号：

R194 [卫生标准、卫生检查、医药管理];

学科分类号：

摘要：

ObjectivesFew studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM).MethodsWe conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse. Inpatient management and hospital outcomes were obtained by chart review. Factors associated with treatment duration and complicated withdrawal were examined.ResultsOf the 594 patients included in this study, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone. The most common medication given was lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%), and phenobarbital (6%). Symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57-0.80) and front loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62-0.92) were associated with reduced treatment duration. Lorazepam (RR, 1.20; 95% CI, 1.02-1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06-1.54) were associated with increased treatment duration. Lorazepam (adjusted odds ratio, 4.30; 95% CI, 1.05-17.63) and phenobarbital (adjusted odds ratio, 6.51; 95% CI, 2.08-20.40) were also associated with complicated withdrawal.ConclusionsOverall, our results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. Health care systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations.

引用

页码：389 / 396

页数：8

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