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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Article info
Publication history
Published online: September 02, 2022
Accepted:
August 31,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
