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Treatment variability and outcome differences in the emergency department management of alcohol withdrawal

Published online by Cambridge University Press:  21 May 2015

Meldon Kahan ,
Bjug Borgundvaag ,
Deana Midmer ,
Diane Borsoi ,
Carol Edwards  and
Noor Ladhani
Meldon Kahan*
Affiliation:
St. Joseph’s Health Centre, Toronto, Ont.
Bjug Borgundvaag
Affiliation:
Mount Sinai Hospital, Toronto, Ont.
Deana Midmer
Affiliation:
Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
Diane Borsoi
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ont.
Carol Edwards
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ont.
Noor Ladhani
Affiliation:
University of Western Ontario, London, Ont.
*
Addiction Medicine Service, St. Joseph’s Health Centre, 33 The Queensway, Toronto ON M6R 1B5; 416 530-6860, fax 416 530-6160, kahanm@stjoe.on.ca

Abstract

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Objective:

Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments.

Methods:

A structured chart audit was performed for patients with alcohol-related problems who presented to 2 Toronto hospitals over a 2-year period.

Results:

A total of 209 emergency department charts were audited. Patient characteristics were similar in both hospitals. None of the patients had been assessed using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Patients at one hospital received substantially higher mean diazepam doses (64 mg v. 26 mg; p < 0.001) than did the patients at the other hospital, and the patients at the first hospital had fewer seizures during their emergency department stay (1% v. 9%; p = 0.012). Patients spent an average of 9 hours and 40 minutes in the emergency department.

Conclusion:

There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.

Keywords

alcohol withdrawalalcohol dependencebenzodiazepines
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 2 , March 2005 , pp. 87 - 92
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

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