Inappropriate Treatment for Alcohol Withdrawal Is Common
Care is poor, despite the existence of proven therapies.
Evidence-based practice guidelines clearly state that patients at risk for alcohol withdrawal should be monitored and treated with benzodiazepines if their risk is high enough or symptoms are substantial. In a retrospective record review, researchers evaluated whether a protocol for such an approach — symptom-triggered therapy — was followed appropriately at two large general hospitals that offer more than 40 specialty services. The protocol — the Revised Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) — employs a symptom assessment that required patients to be able to communicate.
Of 124 inpatients who received symptom-triggered therapy, more than half (52%) were treated inappropriately: 35 had no recent heavy alcohol use and therefore were not at risk for withdrawal, 9 could not communicate well, and 20 had no recent heavy drinking and were unable to communicate. Overall, 11 patients had adverse outcomes (i.e., seizure, delirium, death); 7 of them had received inappropriate treatment.
Comment: People who have not been drinking heavily recently cannot, and should not, be treated for alcohol withdrawal. People who cannot communicate can, and sometimes should, receive withdrawal treatment but not if the decision is based on a symptom scale that requires verbal communication. We should take notice when only half the people with a potentially fatal condition receive appropriate treatment. Known effective treatments exist for alcohol withdrawal, and they are quite straightforward. If the hospitals in this report represent U.S. hospitals generally (as is likely), we have a large challenge to implement appropriate care for this common condition.
Research report; Hecksel KA et al. Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital. Mayo Clin Proc 2008 Mar; 83:274.
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