Appraisal of the Glasgow assessment and management of alcohol guideline: a comprehensive alcohol management protocol for use in general hospitals.
BACKGROUND
Guidelines exist for the management of alcohol withdrawal syndrome (AWS) but few have been assessed as to their suitability for general hospitals. The Glasgow Assessment and Management guideline for alcohol has been specifically developed for use in this context.


OBJECTIVE
To determine if this alcohol assessment guideline aids the management of AWS in general hospitals.


METHODS
The four components of the Glasgow Assessment and Management of Alcohol guideline were evaluated. This included the use of the Fast Alcohol Screening Test (FAST) to identify at risk patients, a risk stratification strategy to indicate fixed dose or symptom-triggered benzodiazepine treatment, the Glasgow Modified Alcohol Withdrawal Scale (GMAWS) for symptom-triggered treatment and a clear recommendation for vitamin prophylaxis of Wernicke's encephalopathy.


METHODS
FAST scores were assessed along with the CAGE (cut down, annoyed, guilty and eye-opener) screening tool to ascertain if a single screening tool could identify hazardous and dependent drinking. The GMAWS and Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) were compared between two medical units. A staff survey of the two AWS tools was also carried out.


RESULTS
FAST was able to identify both probable hazardous and dependent drinking. The GMAWS was reliable and gauged both physical and cognitive aspects of AWS. Staff generally preferred the GMAWS-based treatment as opposed to CIWA-Ar management and welcomed the Guideline as a whole.


CONCLUSIONS
The Glasgow Guideline aids the management of patients with AWS in an acute hospital setting. It allows early identification of at risk patients and directs effective therapeutic intervention.
Acute Addiction Liaison Team, Glasgow Addiction Services, Legal House, 101 Gorbals Street, Glasgow, G5 9DW, UK. andrew.mcpherson@uws.ac.uk
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A
McPherson
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Benson
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EH
Forrest
D001291:Attitude of Health Personnel; D001569:Benzodiazepines / Q000627:therapeutic use; D000431:Ethanol / Q000009:adverse effects*; D019983:Guideline Adherence; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods; D012606:Scotland; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy*; D014815:Vitamins / Q000627:therapeutic use; D014899:Wernicke Encephalopathy / Q000139:chemically induced / Q000517:prevention & control
D014815:Vitamins; D001569:Benzodiazepines; D000431:Ethanol