Hospital culture has changed in the years since the pre-protocol period, with a variety of new approaches to promote earlier discharge. Timing in Relation to Implementation of Protocol; No. The incidence of serious adverse outcomes of treatment with benzodiazepines was not significantly different between the 2 groups. Pharmacological management of alcohol withdrawal. Alcohol withdrawal protocols involving symptom-triggered administration of benzodiazepine have been established to reduce the duration of treatment and the cumulative benzodiazepine dose relative to usual care. Baseline demographic characteristics Table 2 were comparable between the pre- and post-protocol groups, with an average age of 54 SD 10 years and 56 SD 34 years, respectively. There was for better coverage and inclusion of withdrawal symptoms at 36 hours as indicated by total CIWA-Ar score and item frequency.

Admission with seizure or seizure disorder unrelated to alcohol withdrawal. In this study, choice of medication was with treating team of the hospital; however, only either intermediate acting lorazepam or long acting diazepam was used for this purpose. None of the items loaded on more than one factor. Transferred off internal medicine service while receiving active treatment for withdrawal benzodiazepine dose within last 24 h. The possible range of score is 0—

In a previous study by Pittman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. World Health Organization; For the clinical practice, it is advisable not to overdepend caase rating scales and it must not replace a thorough clinical evaluation of the patient’s medical status in prediction of those at risk of severe alcohol withdrawal.

Staff must be trained to recognize cases for which the protocol is appropriate and must be able to commit to the frequent and regular CIWA-Ar monitoring required.

Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital

Support Center Support Center. The mean number of benzodiazepine types administered was 1.


ciwa-ar case study

Total ethanol consumption as a seizure risk factor in alcoholics. Two study periods were identified: The sociodemographic data sheet included age, stury status, religion, community, education, and economic status.

Factor Structure of CIWA-Ar in Alcohol Withdrawal

Table 1 summarizes the sample characteristics. In this study, implementation of an alcohol withdrawal protocol with combination fixed-schedule and symptom-triggered benzodiazepine dosing was associated with improved efficacy and safety of alcohol withdrawal treatment for medical inpatients relative to usual care before implementation of the protocol.

ciwa-ar case study

The factors and their item loadings, with absolute values greater than 0. To avoid confounding withdrawal symptoms, we excluded patients with active opiate, benzodiazepine, or stimulant withdrawal; patients who presented with delirium presumed to be unrelated to alcohol withdrawal; patients with concurrent psychiatric disorders requiring admission to hospital; and patients admitted with seizure or seizure disorder unrelated to alcohol withdrawal.

There was no use of short acting benzodiazepines, which causes varying and rebound withdrawal symptoms across different time frame with cisa-ar dosing and changing plasma concentration.

Factor Structure of CIWA-Ar in Alcohol Withdrawal

A higher benzodiazepine dose was given over a shorter period in the post-protocol group, which signifies that patients were treated more aggressively, with outcomes of reduced treatment duration and cumulative benzodiazepine dose. Can J Hosp Pharm. Variables Mean SD Age Detection of true differences between the combination dosing protocol and an exclusively symptom-triggered dosing protocol will require a future trial directly comparing the 2 approaches.

This article has been cited by other articles in PMC. Support Center Support Center. Conflict of Interests The authors report no conflict of interests.

The use of adrenergic antagonists may have a valuable role in addition to benzodiazepines, in a set of patients with autonomic features. Although the same investigator collected the data for all admissions, the involvement of many different physicians increased the risk of inconsistencies in assessment and inaccuracies in documentation.


The incidence of serious adverse outcomes of treatment with benzodiazepines was not significantly different atudy the 2 groups. This was expected as alcohol withdrawal manifests by simultaneous involvement of all mechanisms rather than any mutually exclusive mechanism.

ciwa-ar case study

However, the earlier resolution of alcohol withdrawal syndrome associated with use of the protocol is likely to contribute to decreasing duration of hospital stay, playing a role in improving patient outcomes and reducing hospital costs.

The shorter median duration of hospital stay for the post-protocol group 3.

The first factor explained Exploratory factor analysis maximum likelihood method was carried out to identify factor structure on all items of CIWA-Ar for day three. Discussion We examined the factor structure of the CIWA-Ar in a population of adult men hospitalized to a tertiary psychiatric institute for treatment of alcohol dependence.

Subjects This was a cross-sectional hospital-based study, conducted at Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, a tertiary care referral centre during May to June ciwa-arr Materials and Methods 2. However, this was offset by the more extensive alcohol withdrawal history in this group, which might have been associated with a higher risk of severe complications of alcohol withdrawal.

We also excluded any comorbid general medical condition especially epilepsy for that reason, patients on antiepileptic either taking it ciwa-arr or skipping will modify the alcohol withdrawal symptoms. Baseline demographic characteristics Table 2 were stuey between the pre- and post-protocol groups, with an average age of 54 SD 10 years ciwa-sr 56 SD 34 years, respectively. Table 4 Secondary Outcomes.

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