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Trauma center admission risk conditions and the probability for developing alcohol withdrawal syndrome: A retrospective study

  • Tiffany D. Marchand
    Correspondence
    Corresponding author at: Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave. Youngstown, OH, 44501.
    Affiliations
    Trauma, Critical Care, and General Surgery Services, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States
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  • C. Michael Dunham
    Affiliations
    Trauma, Critical Care, and General Surgery Services, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States
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  • Elisha A. Chance
    Affiliations
    Trauma and Neuroscience Research Department, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States
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  • Barbara M. Hileman
    Affiliations
    Trauma and Neuroscience Research Department, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States
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Published:September 02, 2022DOI:https://doi.org/10.1016/j.injury.2022.08.072

      Highlights

      • We identified nine high-risk factors for alcohol withdrawal syndrome (AWS) and created a risk score to assess the likelihood of developing AWS.
      • The AWS proportion was greater with a risk score of 5–9 (16.8%) than of 0–4 (1.2%).
      • In the setting of traumatic injury, multiple risk conditions may have additive effects that contribute toward clinical manifestation of AWS.
      • The identified risk conditions may be associated with a hyperadrenergic state.

      Abstract

      Background

      Because the proportion of trauma patients developing alcohol withdrawal syndrome (AWS) is low, AWS risk conditions have not been precisely delineated. We aimed to create multifactor screening strategies to assess probabilities for the likelihood of developing AWS.

      Methods

      We performed a retrospective chart review of 1,011 trauma patients admitted to a Level I trauma center to investigate the associations between AWS and probable AWS risk conditions. Included patients were adults who met trauma registry inclusion criteria and had blood alcohol concentration (BAC) testing performed. Patients were excluded if they had a traumatic brain injury with a Glasgow Coma Score (GCS) ≤ 8, or no BAC testing performed. We defined heavy drinking as daily drinking or >7 per week.

      Results

      AWS had univariate associations with heavy drinking history, Injury Severity Score (ISS) ≥15, psychiatric disorders, liver disease, smoking history, in-hospital bronchodilator administration, age ≥45, male sex, Intensive Care Unit (ICU) admission, serum aspartate aminotransferase (AST) ≥40 U/L, and cognitive preservation (GCS ≥13 with BAC ≥100 mg/dL) (all, p < 0.05). ICU admission, AST ≥40 U/L, cognitive preservation, male sex, and age ≥45 had associations with ISS ≥15 or alcohol misuse (all, p < 0.0001). For patients with age ≥45 and heavy drinking history or age <45 and heavy drinking history with ISS ≥15 and ICU admission, the AWS proportion (15.3%) was greater in comparison to other patients (0.3%). The AWS risk score was the sum of the following nine conditions, assigned a zero when the condition was absent and one when present (range 0–9): ISS ≥15, psychiatric disorders, liver disease, smoking history, in-hospital bronchodilator administration, age ≥45, male sex, AST ≥40 U/L, and cognitive preservation. The AWS proportion was greater with a risk score of 5–9 (16.8%) than of 0–4 (1.2%; p < 0.0001).

      Conclusions

      AWS in the setting of traumatic injury is associated with multiple risk conditions. The presence of multiple risk conditions might have additive effects that could contribute toward a clinical manifestation of AWS. The identified risk conditions may be associated with a hyperadrenergic state.

      Keywords

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