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

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI:10.1097/ADM.0000000000001297

Matthew V Ronan, Kirsha S Gordon, Melissa Skanderson, Michael Krug, Patrick Godwin, Daniel Heppe, Matthew Hoegh, Joel C Boggan, Jeydith Gutierrez, Peter Kaboli, Micah Pescetto, Michelle Guidry, Peter Caldwell, Christine Mitchell, Erik Ehlers, Nazima Allaudeen, Jessica Cyr, Andrea Smeraglio, Peter Yarbrough, Richard Rose, Anand Jagannath, Jaclyn Vargas, Paul B Cornia, Meghna Shah, Matthew Tuck, Cherinne Arundel, James Laudate, Joel Elzweig, Benjamin Rodwin, Joyce Akwe, Meredith Trubitt, Craig G Gunderson

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Abstract

Objectives: Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM).

Methods: We 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.

Results: Of 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.

Conclusions: Overall, 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.

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因酗酒而住院的退伍军人的现代管理和疗效：多中心回顾性队列研究。

目标：很少有研究描述住院环境中的当代戒酒管理，也很少有研究根据美国成瘾医学会（ASAM）的指导方针对当前的做法进行回顾：很少有研究描述住院环境中的当代酒精戒断管理，也很少有研究根据美国成瘾医学会（ASAM）的指南回顾当前的实践：我们对 2018 年 10 月 1 日至 2019 年 9 月 30 日期间在 19 家退伍军人健康管理局（VHA）医院内科或外科病房住院的酒精戒断患者进行了一项回顾性队列研究。人口统计学和合并症数据来自退伍军人健康管理局企业数据仓库。住院管理和住院结果通过病历审查获得。研究了与治疗持续时间和复杂停药相关的因素：在纳入本研究的 594 名患者中，51% 的患者仅接受了症状触发疗法，26% 的患者接受了固定剂量加症状触发疗法，10% 的患者接受了前负荷疗法加症状触发疗法，3% 的患者仅接受了固定剂量疗法。最常用的药物是劳拉西泮（87%），其次是氯氮卓（33%）、地西泮（14%）和苯巴比妥（6%）。单纯症状触发疗法（相对风险 [RR]，0.68；95% 置信区间 [CI]，0.57-0.80）和前负荷与症状触发疗法（RR，0.75；95% 置信区间 [CI]，0.62-0.92）与治疗时间缩短有关。劳拉西泮（RR，1.20；95% CI，1.02-1.41）和苯巴比妥（RR，1.28；95% CI，1.06-1.54）与治疗时间延长有关。劳拉西泮（调整后的几率比为4.30；95% CI为1.05-17.63）和苯巴比妥（调整后的几率比为6.51；95% CI为2.08-20.40）也与复杂的戒断有关：总体而言，我们的研究结果支持美国医学会的指导方针，即使用症状触发疗法来管理使用长效苯二氮卓类药物的患者。使用短效苯二氮卓类药物和固定剂量方案的医疗系统应考虑更新酒精戒断管理路径，以遵循 ASAM 的建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.