Alcohol Withdrawal Syndrome in Trauma Patients: A Trauma Quality Programs Study
Tyler Jones, Bishwajit Bhattacharya, Kevin Schuster, Robert Becher, Lisa Kodadek, Kimberly A. Davis, Adrian A. Maung
Surgery, Yale School of Medicine, New Haven, Connecticut, United States
Objective: Identify the rates and possible predictors of alcohol withdrawal syndrome (AWS) among adult trauma patients.
Design: Retrospective review of a national longitudinal dataset.
Setting: American College of Surgeons Trauma Quality Programs Participant Use File (PUF)
Patients: All adult patients (18 years or older) included in the 2017 and 2018 PUF dataset.
Main Outcome Measure: Rates and predictors of AWS.
Results: 1,677,351 adult patients were included in the analysis. AWS (as defined by the PUF based on the World Health Organization 2016 definition) was reported in 11,056 (0.7%). The rate increased to 0.9% in patients admitted for more than 2 days and 1.1% in those admitted for more than 3 days. AWS patients were more likely to be male (82.7 vs 60.7%, p < 0.001), have history of alcohol use disorder (70.3 vs 5.6%, p < 0.001) and have a positive alcohol screen on admission (68.2 vs 28.6%, p < 0.001). The rates of AWS varied with age (Figure 1) with the highest rates in patients 51-60 years old. In a multivariable logistic regression, history of alcohol use disorder (OR 12.9, 95% CI 12.1-13.7), history of cirrhosis (OR 2.1, 95% CI 1.9-2.3), positive drug screens for barbiturates (OR 2.1, 95% CI 1.6-2.7), tricyclic antidepressants (OR 2.2, 95% CI 1.5-3.1) or alcohol (OR 2.5, 95% CI 2.4-2.7) and AIS Head ≥ 3 (OR 1.7, 95% CI 1.6-1.8) were the strongest predictors for AWS. However, even in patients with the strongest predictors, reported rates of AWS were relatively low: 2.7% of patients with a positive alcohol screen, 7.6% with history of alcohol use disorder and 4.9% with cirrhosis.
Conclusions: Reported AWS after trauma is an uncommon occurrence even in higher risk patient populations.
Figure 1: Rates of AWS across different age groups.
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