John D DelBianco, Kira J Galeano, Gillian A Beauchamp, Ryan M Surmaitis, Stephanie E Shara, Alison Sutter, Hope Kincaid, Joseph J Stirparo, Kathryn L Wheel, Alexandra M Amaducci
{"title":"急性护理环境中医学毒理学家戒酒管理的趋势:2016-2022年毒理学调查联盟(ToxIC)核心登记处的分析","authors":"John D DelBianco, Kira J Galeano, Gillian A Beauchamp, Ryan M Surmaitis, Stephanie E Shara, Alison Sutter, Hope Kincaid, Joseph J Stirparo, Kathryn L Wheel, Alexandra M Amaducci","doi":"10.1093/alcalc/agaf047","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Alcohol withdrawal syndrome (AWS) requires urgent treatment to prevent morbidity and mortality. In the acute care setting, medical toxicologists play a critical role in AWS management, including the use of gamma-aminobutyric acid agonists and adjunctive medications. We aim to introduce the addiction medicine community to this role by describing clinical presentation and treatment of patients with AWS in the Toxicology Investigators Consortium Core Registry.</p><p><strong>Methods: </strong>Medical toxicologists from participating sites enter demographic, exposure, clinical presentation, and treatment data on all patients they evaluate into the Core Registry. This was a secondary analysis of registry patients evaluated for AWS from 2016 to 2022. Data were coded in a spreadsheet and analyzed using descriptive statistics.</p><p><strong>Results: </strong>We included 1093 cases. Agitation and delirium/toxic psychosis were documented in 373 (34.1%) and 227 (20.8%) patients, respectively. Benzodiazepines were the most common gamma-aminobutyric acid agonist treatment (n = 539, 49.3%). There was an overall decrease in the use of benzodiazepines alone and increases in the use of phenobarbital, ketamine, and dexmedetomidine. Intubation was performed in 115 (10.5%) patients. Naltrexone, used for alcohol use disorder, was given in 88 (8.1%) cases. The absolute number of AWS cases increased during this period.</p><p><strong>Conclusions: </strong>Use of benzodiazepines alone to manage AWS decreased while phenobarbital, ketamine, and dexmedetomidine use increased. Many patients had severe withdrawal manifestations, and some received alcohol use disorder treatment, suggesting that medical toxicologists see more severe cases in the acute care setting and have an opportunity to address the underlying use disorder.</p>","PeriodicalId":7407,"journal":{"name":"Alcohol and alcoholism","volume":"60 5","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309239/pdf/","citationCount":"0","resultStr":"{\"title\":\"Trends in alcohol withdrawal management by medical toxicologists in the acute care setting: an analysis of the Toxicology Investigators Consortium (ToxIC) Core Registry, 2016-2022.\",\"authors\":\"John D DelBianco, Kira J Galeano, Gillian A Beauchamp, Ryan M Surmaitis, Stephanie E Shara, Alison Sutter, Hope Kincaid, Joseph J Stirparo, Kathryn L Wheel, Alexandra M Amaducci\",\"doi\":\"10.1093/alcalc/agaf047\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Alcohol withdrawal syndrome (AWS) requires urgent treatment to prevent morbidity and mortality. In the acute care setting, medical toxicologists play a critical role in AWS management, including the use of gamma-aminobutyric acid agonists and adjunctive medications. We aim to introduce the addiction medicine community to this role by describing clinical presentation and treatment of patients with AWS in the Toxicology Investigators Consortium Core Registry.</p><p><strong>Methods: </strong>Medical toxicologists from participating sites enter demographic, exposure, clinical presentation, and treatment data on all patients they evaluate into the Core Registry. This was a secondary analysis of registry patients evaluated for AWS from 2016 to 2022. Data were coded in a spreadsheet and analyzed using descriptive statistics.</p><p><strong>Results: </strong>We included 1093 cases. Agitation and delirium/toxic psychosis were documented in 373 (34.1%) and 227 (20.8%) patients, respectively. Benzodiazepines were the most common gamma-aminobutyric acid agonist treatment (n = 539, 49.3%). There was an overall decrease in the use of benzodiazepines alone and increases in the use of phenobarbital, ketamine, and dexmedetomidine. Intubation was performed in 115 (10.5%) patients. Naltrexone, used for alcohol use disorder, was given in 88 (8.1%) cases. The absolute number of AWS cases increased during this period.</p><p><strong>Conclusions: </strong>Use of benzodiazepines alone to manage AWS decreased while phenobarbital, ketamine, and dexmedetomidine use increased. Many patients had severe withdrawal manifestations, and some received alcohol use disorder treatment, suggesting that medical toxicologists see more severe cases in the acute care setting and have an opportunity to address the underlying use disorder.</p>\",\"PeriodicalId\":7407,\"journal\":{\"name\":\"Alcohol and alcoholism\",\"volume\":\"60 5\",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-07-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309239/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Alcohol and alcoholism\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/alcalc/agaf047\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SUBSTANCE ABUSE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Alcohol and alcoholism","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/alcalc/agaf047","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SUBSTANCE ABUSE","Score":null,"Total":0}
Trends in alcohol withdrawal management by medical toxicologists in the acute care setting: an analysis of the Toxicology Investigators Consortium (ToxIC) Core Registry, 2016-2022.
Aims: Alcohol withdrawal syndrome (AWS) requires urgent treatment to prevent morbidity and mortality. In the acute care setting, medical toxicologists play a critical role in AWS management, including the use of gamma-aminobutyric acid agonists and adjunctive medications. We aim to introduce the addiction medicine community to this role by describing clinical presentation and treatment of patients with AWS in the Toxicology Investigators Consortium Core Registry.
Methods: Medical toxicologists from participating sites enter demographic, exposure, clinical presentation, and treatment data on all patients they evaluate into the Core Registry. This was a secondary analysis of registry patients evaluated for AWS from 2016 to 2022. Data were coded in a spreadsheet and analyzed using descriptive statistics.
Results: We included 1093 cases. Agitation and delirium/toxic psychosis were documented in 373 (34.1%) and 227 (20.8%) patients, respectively. Benzodiazepines were the most common gamma-aminobutyric acid agonist treatment (n = 539, 49.3%). There was an overall decrease in the use of benzodiazepines alone and increases in the use of phenobarbital, ketamine, and dexmedetomidine. Intubation was performed in 115 (10.5%) patients. Naltrexone, used for alcohol use disorder, was given in 88 (8.1%) cases. The absolute number of AWS cases increased during this period.
Conclusions: Use of benzodiazepines alone to manage AWS decreased while phenobarbital, ketamine, and dexmedetomidine use increased. Many patients had severe withdrawal manifestations, and some received alcohol use disorder treatment, suggesting that medical toxicologists see more severe cases in the acute care setting and have an opportunity to address the underlying use disorder.
期刊介绍:
About the Journal
Alcohol and Alcoholism publishes papers on the biomedical, psychological, and sociological aspects of alcoholism and alcohol research, provided that they make a new and significant contribution to knowledge in the field.
Papers include new results obtained experimentally, descriptions of new experimental (including clinical) methods of importance to the field of alcohol research and treatment, or new interpretations of existing results.
Theoretical contributions are considered equally with papers dealing with experimental work provided that such theoretical contributions are not of a largely speculative or philosophical nature.