The Severity of Ethanol Withdrawal Scale in Scale-Driven Alcohol Withdrawal Treatment: A Quality Assurance Study

Abstract

ABSTRACTThis quality assurance study compared two scales that drive the medicinal treatment of alcohol withdrawal syndrome (AWS): the new Severity of Ethanol Withdrawal Scale (SEWS) and the default Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar). Prospectively entered outcome data from medical intensive care (SEWS) and acute psychiatric inpatient (CIWA-Ar) units were collected and analyzed. Measures included scale administration patterns, mean lengths of time on treatment medication, and mean medication doses for the first 24 hours and for the total AWS episode. The administration patterns of the two scales were highly associated despite separate ward locations and personnel. Time-on-medication for SEWS patients shortened on average by one hospital day over the CIWA-Ar group. At the same time, however, total chlordiazepoxide doses, or the first 24 hours and over the total AWS episode, averaged twice the magnitude in the SEWS group over the CIWA-Ar. The data suggest that the SEWS shortens AWS course of treatment significantly, likely due to better assessment leading to improved medication treatment early in the course. Contributing SEWS scale factors may include item weighting, dichotomous item scoring, and ease of scale use by the nursing staff. New prospective studies should focus on these clinical metrics along with reference to biological mechanisms of an apparent improved treatment effect using the SEWS.