The Results of Clinical Practice Guidelines for the Treatment of Alcoholic Withdrawal Syndrome in Inpatients, Nadun Hospital.

Abstract

     Nadun hospital, a small community hospital, has developed clinical practice guidelines for the pharmacological treatment of alcohol withdrawal patients in order to improve standardization of practice, rapid symptomatic control, shorten treatment time, reduce referrals, and without major complications. The aims were to evaluate outcomes on remission rate and duration. This was a prospective descriptive study of inpatients diagnosed with mental and behavioral disorders due to use of alcohol (F10.x) having Clinical Institute Withdrawal Assessment for Alcohol-Revised version (CIWA-Ar) score of 8 or above between 1 December 2016 and 31 March 2019. Remission was defined as when the patient was scoring below 8 on CIWA-Ar for 24 hours. Statistical analysis was performed using percentage, mean, median, and survival analysis. There were 71 patients diagnosed with F10.x, 60.6% had alcoholic withdrawal symptoms, and 14.1% had CIWA-Ar below a score of 8 during the hospitalization. The 33 patients were included in this study. The overall remission rate was 93.9% and the remission rate on day 3, 4, 5 of treatment was 68.8%, 77.4%, and 90.3% respectively. The median remission time was on day 2 of treatment (95% CI: 1.42-2.79). Patients with moderate symptoms had median remission time on day 1.67 (95% CI: 1.38-2.00) while patients with very severe symptoms had median remission time on day 4.33 (95% CI: 1.38-5.54). Average benzodiazepines received equivalent to diazepam was 171.73 (±165.05) mg and average intravenous diazepam was 44.24 (±68.65) mg. There were no major complications or mortality during treatment. The clinical practice guidelines for alcoholic withdrawal syndrome was effective, rapid symptomatic control and safe.