Replacing the Clinical Institute Withdrawal Assessment—Alcohol revised with the modified Richmond Agitation and Sedation Scale for alcohol withdrawal to support management of alcohol withdrawal symptoms: potential impact on length of stay and complications
Jane de Lemos, Mazen Sharaf, Susanne Moadebi, Sophie Low-Beer, Brighid Cassidy, Jason M. Sutherland, Christine Deziel, Sree Nagendran
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引用次数: 0
Abstract
Purpose
We evaluated impact on length of stay and possible complications of replacing the Clinical Institute Withdrawal Assessment—Alcohol Revised (CIWA-Ar) scale with a slightly modified Richmond Agitation and Sedation Scale (mRASS-AW) to support managing patients admitted with alcohol withdrawal symptoms in a community hospital. Since mRASS-AW is viewed as easier and quicker to use than CIWA-Ar, provided use of mRASS-AW does not worsen outcomes, it could be a safe alternative in a busy ED environment and offer an opportunity to release nursing time to care.
Methods
Retrospective time-series analysis of mean quarterly length of stay. All analyses exclusively used our hospital’s administrative discharge diagnoses database. During April 1st 2012 to December 14th 2014, the CIWA-Ar was used in the ED and in-patient units to guide benzodiazepine dosing decisions for alcohol withdrawal symptoms. After this point, CIWA-Ar was replaced with mRASS-AW. Data was evaluated until December 31st 2020. Primary outcome: mean quarterly length of stay. Secondary outcomes: delirium, intensive care unit (ICU) admission, other post-admission complications, mortality.
Results
N = 1073 patients. No association between length of stay and scale switch (slope change 0.3 (95% CI − 0.03 to 0.6), intercept change, 0.06 (− 0.03 to 0.2). CIWA-Ar (n = 317) mean quarterly length of stay, 5.7 days (95% 4.2–7.1), mRASS-AW (n = 756) 5.0 days (95% CI 4.3–5.6). Incidence of delirium, ICU admission or mortality was not different. However, incidence of other post-admission complications was higher with CIWA-Ar (6.6%) than mRASS-AW (3.4%) (p = 0.020).
Conclusions
This was the first study to compare patient outcomes associated with using mRASS-AW for alcohol withdrawal symptoms outside the ICU. Replacing CIWA-Ar with mRASS-AW did not worsen length of stay or complications. These findings provide some evidence that mRASS-AW could be considered an alternative to CIWA-Ar and potentially may provide an opportunity to release nursing time to care.
期刊介绍:
CJEM is a peer-reviewed journal owned by CAEP. CJEM is published every 2 months (January, March, May, July, September and November). CJEM presents articles of interest to emergency care providers in rural, urban or academic settings. Publishing services are provided by the Canadian Medical Association.