title: Experience with an adult alcohol withdrawal syndrome practice guideline in internal medicine patients.
abstract: OBJECTIVE
  To standardize treatment of alcohol withdrawal syndrome (AWS) in internal medicine patients using an adult AWS practice guideline with a symptom-triggered management approach.
  
  
  METHODS
  Prospective interventional (pilot group) and retrospective (control group).
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Thirty-two internal medicine patients identified as being at risk for AWS and treated according to the AWS practice guideline who were compared with 49 internal medicine patients managed with nonstandardized approaches.
  
  
  METHODS
  Patients in the pilot group were assessed using the AWS type indicator. They received lorazepam, clonidine, or haloperidol, based on AWS type indicator assessment and adult AWS practice guideline criteria.
  
  
  RESULTS
  Data collected and analyzed were drugs administered to control AWS symptoms, use of sitters and physical restraints, length of hospital stay, and discharge from hospital receiving tapered drug therapy. Pilot patients received 46.6% less benzodiazepine (p=0.001), 20% more clonidine (p=0.01), and 18.2% more haloperidol (p=0.002) than control patients. No drug therapy was required in 19% of pilot patients compared with 2% of controls (p=0.01). Significantly more control (71.4%) than pilot patients (18.8%) were discharged with tapered benzodiazepine therapy (p<or=0.01). No significant differences were found between groups for sitters, restraints, or hospital length of stay.
  
  
  CONCLUSIONS
  This pilot project suggests that internal medicine patients at risk for AWS can be managed with a standardized, symptom-triggered approach using decreased amounts of benzodiazepine in combination with adjunctive agents to treat adrenergic hyperactivity and delirium. Further data are necessary to determine the impact of the practice guideline on patient outcome measurements.
authors.affiliation: Department of Therapeutic Services, Medical University of South Carolina, Charleston, South Carolina 29425, USA. stanleyk@musc.edu
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stanley
authors.forename: Cathy L
authors.initials: CL
authors.lastname: Worrall
authors.forename: Shayna L
authors.initials: SL
authors.lastname: Lunsford
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.forename: Justin G
authors.initials: JG
authors.lastname: Miller
authors.forename: Anne P
authors.initials: AP
authors.lastname: Spencer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D006220:Haloperidol / Q000627:therapeutic use; D006784:Hospitals, Teaching; D007388:Internal Medicine; D007902:Length of Stay; D008140:Lorazepam / Q000627:therapeutic use; D010865:Pilot Projects; D012149:Restraint, Physical; D012189:Retrospective Studies; D016896:Treatment Outcome; D017410:Practice Guidelines as Topic
chemical_list: D000316:Adrenergic alpha-Agonists; D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D003000:Clonidine; D006220:Haloperidol; D008140:Lorazepam