Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients

Objective: To assess the efficacy of symptom-triggered therapy vs usual car e for alcohol withdrawal syndrome (AWS) in medical inpatients. Patients and Methods: This study was a retrospective analysis of patients a dmitted to general medical services between January 1, 1995, and December 3 1, 1998, who experienced AWS during the admission. This study was conducted at Saint Marys Hospital, Rochester, Minn. Patients were identified from ho spital discharge diagnoses and pharmacy data. Symptom-triggered therapy for AWS was initiated in 1997. Patients were divided into preimplementation (1 995-1996) and postimplementation (1997-1998) cohorts. Age, sex, medical com orbid conditions, previous AWS (including seizures and delirium tremens), d uration of treatment for AWS, benzodiazepine use and dose, complications of AWS, and adverse outcomes of treatment during the incident admission were abstracted from the medical records of eligible patients. Comorbid conditio ns were classified according to the Charlson comorbidity index. Differences between the cohorts were assessed with use of logistic regression models a nd analysis of covariance. Results: Review of medical records from 638 admissions (536 patients) yield ed 216 admissions eligible for this study. After adjustment for age, sex, C harlson comorbidity index, previous AWS, previous alcohol withdrawal seizur es, and previous delirium tremens, we found no significant difference betwe en cohorts for duration of treatment (P=.16), benzodiazepine use (P=.21), t otal dose of benzodiazepine (P=.38), or total complication rate (P=.053). W e did observe a significant difference in the occurrence of delirium tremen s between the 2 treatment groups (P=.04). This was especially apparent for patients with no history of delirium tremens. Conclusions: Symptom-triggered therapy is effective treatment for AWS in me dical inpatients. In this retrospective study, it did not result in shorter duration of treatment but was associated with a decreased occurrence of de lirium tremens, the most severe and life-threatening complication of AWS. T his result was most apparent in patients with no history of delirium tremen s.