Assessment of a modified MINDS-based protocol for management of alcohol withdrawal syndrome on an inpatient medical service.

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pharmacotherapy Pub Date : 2023-12-01 Epub Date: 2023-08-11 DOI:10.1002/phar.2855
Kevin M Krcmarik, Benjamin J Hulley, Jiayi Huang, Derek Juang, Peter Cadman, Charisma Urbiztondo, Christine Vo, Jaclyn Vargas, Ramin Motarjemi, Tarlan Moinizandi, Brian Kwan
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Abstract

Objective: To determine if a novel symptom-based alcohol withdrawal syndrome (AWS) protocol in a US Veterans cohort leads to significant clinical improvements in patient outcomes and safety.

Background: Prior studies of AWS management, oftentimes using the revised version of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) index, have demonstrated the effectiveness of symptom-triggered therapy for AWS. The Minnesota Detoxification Scale (MINDS) is an alternative to the CIWA-Ar index but remains unevaluated outside of the intensive care unit (ICU) setting. This study assesses outcomes in AWS management prior to and after the implementation of a novel MINDS-based AWS protocol (SDAWP) utilizing a revised MINDS index (MINDS-rev) in an inpatient medical ward setting.

Methods: Retrospective cohort study including encounters prior to (n = 342) and after (n = 338) the implementation of the protocol. Pre- and post-protocol encounters were selected by combinations of diagnostic codes and charting elements. Outcome measures of AWS management were obtained in both groups. The primary endpoint was median total benzodiazepine exposure. Secondary outcomes included median length of hospitalization, median duration of benzodiazepine administration, and the incidence of complications.

Results: The median total benzodiazepine exposure in the post-SDAWP group was significantly lower than the pre-SDAWP group (21.2 vs. 12.0 mg, p < 0.0001) and for a significantly shorter median duration of time (4.0 vs. 3.0 days, p < 0.0001). There was no significant difference in the median length of stay (4.0 vs. 4.0 days, p = 0.50). The incidence of delirium tremens (21 vs. 7, p = 0.01) and need for transfer to a higher level of care (33 vs. 12, p = 0.002) was significantly lower in the post-SDAWP group.

Conclusion: The SDAWP has provided significant improvements in AWS management in our institution and may potentially serve as a template for wider use in other inpatient settings.

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对住院医疗服务中酒精戒断综合征管理改进的基于minds的方案的评估
目的:确定在美国退伍军人队列中,一种新的基于症状的酒精戒断综合征(AWS)方案是否能显著改善患者预后和安全性。背景:先前对AWS管理的研究,通常使用修订版的临床研究所酒精戒断评估(CIWA-Ar)指数,已经证明了症状触发疗法对AWS的有效性。明尼苏达州戒毒量表(MINDS)是CIWA-Ar指数的替代方案,但在重症监护病房(ICU)设置之外仍未进行评估。本研究利用修订后的MINDS指数(MINDS-rev)在住院病房环境中评估实施新型基于MINDS的AWS协议(SDAWP)之前和之后的AWS管理结果。方法:回顾性队列研究,包括实施方案之前(n = 342)和之后(n = 338)的遭遇。通过诊断代码和图表元素的组合选择方案前后的接触。两组均获得AWS管理的结局指标。主要终点是苯二氮卓类药物总暴露的中位数。次要结局包括住院时间中位数、苯二氮卓类药物使用时间中位数和并发症发生率。结果:SDAWP后组的苯二氮卓类药物总暴露中位数显著低于SDAWP前组(21.2 mg vs 12.0 mg, p)。结论:SDAWP显著改善了我院的AWS管理,并可能作为其他住院患者更广泛使用的模板。
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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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