The inclusion of fixed-schedule doses in the protocol may prolong the duration of treatment and lead to overtreatment of patients. Firstly, many of the patients come for admission after 12 to 18 hours of abstinence and severe withdrawal, so keeping them drug free was ethically not possible. No other benzodiazepines were used in the post-protocol group, but in the pre-protocol group, clonazepam was given in 2 admissions and midazolam in 1 admission. In this study, choice of medication was with treating team of the hospital; however, only either intermediate acting lorazepam or long acting diazepam was used for this purpose. Alcohol withdrawal protocols involving symptom-triggered administration of benzodiazepine have been established to reduce the duration of treatment and the cumulative benzodiazepine dose relative to usual care. The primary outcome was the duration of benzodiazepine treatment for alcohol withdrawal, defined as the time difference in hours between the first and last doses given in hospital, including doses given in the emergency department.
Information on patient’s demographics, treatment history, past history, and family history was obtained from interviews with patients and accompanying person. Although symptom-triggered dosing regimens have been well studied and are well recognized for the treatment of alcohol withdrawal, they have not been universally adopted, possibly because institutions are unable to carry out the required CIWA-Ar monitoring. One of the limitations in our study is that it includes male only patients; however, gender can be an important issue in AWS presentation and its severity. Factor Analysis Factor analysis extraction method-maximum likelihood with the 10 items of CIWA-Ar for day three, resulted in initial three factors with eigenvalues greater than unity. Not admitted to internal medicine service with minimum 24 h stay in hospital. Open in a separate window.
On alcohol-dependent male patients seeking treatment for alcohol withdrawal at 36 hours of abstinence. Secondly, many other patients were referred from primary care centers with initial management, including long acting benzodiazepines like diazepam that masks the AWS. The collected data on patients was statistically analyzed, using statistical package for social sciences SPSS, Inc.
Tools Sociodemographic Data Sheet. Hence rating at the 24 hours of abstinence was considered as first rating.
A score greater than 15 points indicates severe withdrawal. The knowledge of these casee factors may enhance our understanding of AWS and better prediction of complications thus management plans. The shorter median duration of hospital stay for the post-protocol group 3. These medications with CNS depressant effect do mask and modify the withdrawal symptoms. Regardless, the protocol has not increased risks or introduced disadvantages in relation to any of these parameters.
For the 72 patients who completed treatment, the protocol was in effect for a median duration of ciw-ar IQR 39—95 h. The median duration of benzodiazepine treatment for alcohol withdrawal declined significantly after introduction of the combination protocol: This article has been cited by other articles in PMC.
The study by Pittman et al.
The CIWA-Ar protocol dictates the period for which monitoring is required and whether a benzodiazepine dose should be administered. These two items represent some mixed rather than any specific mechanism. This study finds multidimensionality of alcohol withdrawal symptoms as measured with CIWA-Ar; we found three factors explaining Use of adjunctive medications for treatment of alcohol withdrawal.
cse Additionally our data analysis had CIWA-Ar ratings of day two 36 hours of admission with suppression of withdrawal symptoms from detoxification medications, that is, benzodiazepines. The most common reasons for exclusion csse admission with seizure or seizure disorder unrelated to alcohol withdrawal, regular use of benzodiazepines before admission, and no doses of benzodiazepine after transfer out of the emergency department. Using a viwa-ar increases the uniformity of treatment, especially in large teaching hospitals where regimens are prescribed by physicians of varied experiences and expertise.
The severity of withdrawal symptoms and appearance of complete sets of withdrawal symptoms at the 36th hour may have been influenced by plasma half-life of benzodiazepams being used for detoxification. A comparison of rating scales for the alcohol-withdrawal syndrome.
All admissions were included in the evaluation of safety outcomes, and all 79 post-protocol admissions were assessed for quality assurance outcomes.
This item scale, which takes approximately 5 min to administer, helps to determine the need for medication and additional monitoring, 67 thereby decreasing the risk of under- or over-treatment. Assessable data were available for 71 charts from the ciiwa-ar period and 72 charts from the post-implementation period.
Kaiser-Meyer-Olkin measure of sample adequacy and Bartlett’s test of sphericity were also done to assess appropriateness of conducting factor analysis. We examined whether the protocol stydy warranted for ciaw-ar patients to whom it had been applied, as defined by the following criteria: Treatment extended a median of Factor analysis extraction method-maximum likelihood with the casr items of CIWA-Ar for day three, resulted in initial three factors with eigenvalues greater than unity.
There were few severe adverse outcomes overall, so the failure to studj a significant difference may have resulted from the small sample size. In our setup, we use CIWA-Ar as part of the measure for the management of alcohol withdrawal symptoms.
The averages of each rating of CIWA-Ar scores were computed to see the severity of withdrawal symptoms across time span of abstinence. Factor Analysis Factor analysis extraction method-maximum likelihood with the 10 items of CIWA-Ar for day three, resulted in initial three factors with eigenvalues greater than unity.
It probably represents mixed mechanism of CNS rebound hyperactivity along with adrenal hyperactivity.