Alcohol Withdrawal Syndrome in Trauma Patients: A Prospective Cohort Study

Abstract

Introduction: Trauma patients with a positive blood alcohol concentration (BAC) are often believed to be at high risk for the alcohol withdrawal syndrome (AWS). Therefore some centers prophylaxis all BAC positive patients. This study prospectively measures the incidence of AWS among trauma patients admitted to the hospital who have consumed alcohol and determines their risk factors for AWS. Methods: A cohort of trauma patients admitted to a non-ICU hospital setting was prospectively monitored for the development of AWS during the first 10 days of hospitalization. The 10-item Alcohol Use Disorders Identification Test (AUDIT) and questions about alcohol withdrawal history were administered on the first day and the revised Clinical Institute for Withdrawal of Alcohol Scale (CIWA-Ar) was administered daily. Results: 113 patients were followed through discharge or for the first 10 days of hospitalization. 74.3% (n = 84) reported drinking alcohol. Of the 89 patients with a measured BAC, 25 (28%) were positive. Mean BAC for positive patients was 187.7 mg/dl. No person who denied drinking had a measurable BAC or developed AWS. Among the 84 drinkers, 3 were diagnosed with AWS by CIWA-Ar (3.6% risk), giving an incidence rate of 1.4 episodes per 100 patient days. All patients developing AWS admitted to a previous history of AWS symptoms upon stopping drinking. All AWS patients drank at least 2-3 times per week compared to only 37% of drinkers who did not develop AWS (p = .05). Positive response to dependence items from the AUDIT were highly associated with AWS risk (67% AWS vs 16% non-AWS, p = .005). Implementation of a prophylaxis protocol for all positive BAC would have resulted in 88% (22/25) of BAC positive patients receiving unwarranted medication. Conclusion: AWS has a low incidence rate among intoxicated trauma patients admitted to a non-ICU setting. It is associated with frequent drinking and is found in patients who report dependence symptoms. Patients can reliably tell physicians whether they are at risk for AWS. Routine prophylaxis for positive BAC patients will likely result in substantial excess medication use.