To assess the duration of alcohol withdrawal treatment and the total amount of benzodiazepine administered, patients with early discontinuation of alcohol withdrawal therapy were excluded. Alcohol withdrawal syndrome, which is prevalent among hospital inpatients who are heavy and prolonged drinkers, 1 results from abrupt cessation of chronic alcohol use. This was a cross-sectional hospital-based study, conducted at Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, a tertiary care referral centre during May to June For that matter any psychotropic drugs causing CNS depression or any effecting stimulants will alter the withdrawal symptoms. Using a protocol increases the uniformity of treatment, especially in large teaching hospitals where regimens are prescribed by physicians of varied experiences and expertise.

To simulate similar admission conditions, patients in the pre-protocol group had to have been transferred out of the emergency department at some time during their hospital stay and had to have received at least one dose of benzodiazepine for treatment of alcohol withdrawal. Among them, the most commonly used observer-rated scale is the item clinical institute withdrawal assessment-alcohol, revised CIWA-Ar [ 10 ]. Family history of mental illness included affective disorder in 9. Patients who left against medical advice while still receiving active treatment for withdrawal were also excluded. Previous studies have established the advantages of protocols based exclusively on symptom-triggered benzodiazepine dosing, typically comparing this form of dosing with usual care, where fixed-schedule and symptom-triggered dosing are prescribed without guidance from a protocol. Further studies may also be carried out including cases of mild to moderate severity and in both sex to uncover the differences.

A randomized double-blind controlled trial. It is the most widely used and studied item alcohol withdrawal monitoring scale, which excludes vital sign abnormalities. Thirdly, many other patients came even before onset of withdrawal and in a state of intoxication; the AWS was not fully evolved in terms of range of symptoms and severity.


Meanwhile management and medications were continued as per ward protocol and no adjustment for study purpose was done. Furthermore, some contribution of nutritional and specific vitamin deficiencies, such as thiamine and folate, and associated peripheral neuropathy probably add to these perceptual disturbances.

It was developed from the item clinical institute withdrawal assessment for alcohol and it has been studied across various geographic locations. In this study, implementation of an alcohol withdrawal protocol with combination fixed-schedule and symptom-triggered benzodiazepine dosing was associated with improved efficacy and safety of alcohol withdrawal ciwx-ar for medical inpatients relative to usual care before implementation of the protocol.

In these ciwa-aar, the addition of protocol-guided, fixed-schedule dosing might reduce the risk of undertreating patients because of inaccurate CIWA-Ar scores.

ciwa-ar case study

Early discontinuation was defined in the pre-protocol group on the basis of transfer or discharge from the internal medicine service ciwa-r receiving active withdrawal treatment i. Discussion We examined the factor structure of the CIWA-Ar in a population of adult men hospitalized to a tertiary psychiatric institute for treatment of alcohol dependence. Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital.

Not admitted to internal medicine service with minimum 24 h stay in hospital. P values less than 0.

Implementation in at least the emergency department would help to reduce the delay in initiating the protocol for cqse patients and might therefore further increase the benefits observed with the protocol.

National Center for Biotechnology InformationU. Study personnel identified an opportunity to optimize management of patients with alcohol withdrawal. J Gen Intern Med.

Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital

Demographics Table 1 summarizes the sample characteristics. The shorter median duration of hospital stay for the post-protocol group 3. A score of 8 points or less indicates mild withdrawal and patients scoring less than 10 do not cqse need additional medication for withdrawal.


Timing in Relation to Implementation of Protocol; No. Request for trained team response to behavioural emergency.

ciwa-ar case study

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Hall W, Zador D. Hence rating at the 24 hours of abstinence was considered as first rating. Please review our privacy policy.

To assess the duration of alcohol withdrawal treatment and the total amount of benzodiazepine administered, patients with early discontinuation of alcohol withdrawal therapy were excluded.

Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital

Table 1 summarizes the sample characteristics. Although there were fewer severe adverse outcomes of benzodiazepines in the post-protocol group than in the pre-protocol group, the difference was not statistically significant. This is an stud access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ciwa-ar case study

This simultaneous involvement of several other neurotransmitters besides GABA and NMDA, like noradrenaline, acetylcholine, and dopamine as well as hormones and electrolytes [ 1718 ] will affect the symptom presentation.

Fixed-schedule dosing may have functioned as a type of buffer: Median duration of benzodiazepine therapy IQR h. We found a three-factor solution based on rotated eigenvalues and scree plot analysis.