A model for predicting alcohol withdrawal delirium.
OBJECTIVE
The aim of this study was to develop a model for identifying patients with a high risk of developing alcohol withdrawal delirium after assessment in the emergency department.


METHODS
Patients seeking acute treatment for alcohol withdrawal at St. Göran's hospital in Stockholm were evaluated for known risk factors for alcohol withdrawal delirium. All patients with any risk factor were admitted to the hospital and received standard treatment with benzodiazepines. All patients were evaluated at admission by the physician in charge at the psychiatric and dependency emergency unit at the hospital. Treatment and final assessment were conducted at the unit's inpatient acute-treatment facility. Correlations were determined between risk factors noted at admission and development of alcohol withdrawal delirium, as defined in DSM-IV, after admission. A total of 334 alcohol-dependent patients were included in the study.


RESULTS
Twenty-three patients, or 6.9 percent, developed alcohol withdrawal delirium after admission despite benzodiazepine treatment. In a stepwise multiple regression model, five risk factors were significantly correlated with the development of alcohol withdrawal delirium: current infectious disease; tachycardia, defined as a heart rate above 120 beats per minute at admission; signs of alcohol withdrawal accompanied by an alcohol concentration of more than 1 gram per liter of body fluid; a history of epileptic seizures; and a history of delirious episodes. No patient without these five risk factors developed delirium.


CONCLUSIONS
Assessment for five easily detectable risk factors can enable the clinician to make an accurate and quantitative assessment of a patient's risk of developing alcohol withdrawal delirium.
Palmstierna
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Department of Clinical Neuroscience, Center for Dependency Disorders at St. Göran's Hospital, Karolinska Institute, Stockholm, Sweden. tom.palmstierna@mailbox.euromail.se
D000430:Alcohol Withdrawal Delirium / Q000453:epidemiology / Q000517:prevention & control*; D004637:Emergency Services, Psychiatric; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D012044:Regression Analysis; D012306:Risk; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000628:therapy; D013548:Sweden / Q000453:epidemiology
D000431:Ethanol