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. The Pittman et al. Previous studies have established the advantages of protocols based exclusively on symptom-triggered benzodiazepine dosing, typically comparing this form of dosing with usual care, where fixed-schedule and symptom-triggered dosing are prescribed without guidance from a protocol. Because the protocol was implemented only on specific hospital wards and not in the emergency department, a delay from the time of admission to initiation and administration of the protocol was inevitable. On alcohol-dependent male patients seeking treatment for alcohol withdrawal at 36 hours of abstinence. Family history of substance dependence was present in Scree plot, showing three factors above eigenvalue of one and showing clear inflexion of the graph.
Lechtenberg R, Worner TM. In a study of medical and surgical inpatients, Hecksel and others 12 found that the protocol was inappropriately applied to more than half of the patients, many of whom were unable to respond reliably to the CIWA-Ar questions. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: It is generally observed that alcohol withdrawal symptoms fluctuate in presentation and severity across time. First factor had loading from four items Further progression of alcohol withdrawal, we could not found beyond 36 hours, may be due to effects of continued medications for withdrawal suppression. It is the most widely used and studied item alcohol withdrawal monitoring scale, which excludes vital sign abnormalities.
Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital
Conflict of Interests The authors report no conflict of interests. Two items of CIWA-Ar, namely, auditory disturbances and tactile disturbances were very infrequent in our sample 9. Therefore, three factors were retained, which captured Left against medical advice while receiving active treatment for withdrawal benzodiazepine dose within last srudy h.
None of the items loaded on more than one factor. A three-factor solution was obtained that accounted for Timing in Stury to Implementation of Protocol; No. Hesitation in trusting exclusively symptom-triggered dosing may stem from lack of staff who are trained and familiar with the CIWA-Ar—based alcohol withdrawal protocol. Patients in the post-protocol group had to have been admitted to one of the internal medicine wards where the protocol had casee implemented and had to have received at least one dose of benzodiazepine according to the protocol.
The collected data on patients was statistically analyzed, using statistical package for social sciences SPSS, Inc. In a study of medical and surgical inpatients, Hecksel and others 12 found that the protocol was inappropriately applied to more than half of the patients, many of whom were unable to respond reliably to the CIWA-Ar questions.
Subjects This was a cross-sectional hospital-based study, conducted at Centre dase Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, a tertiary care referral centre during Stufy to June Several rating instruments have been used to measure severity of alcohol withdrawal [ 9 ]. Pharmacological management of alcohol withdrawal.
Factor Structure of CIWA-Ar in Alcohol Withdrawal
The median duration of benzodiazepine treatment and the median total benzodiazepine dose for withdrawal were compared for the primary outcome using the Mann—Whitney U test. Total ethanol consumption as a seizure risk factor in alcoholics. Support Center Support Center.
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. P values less than 0.
Factor Structure of CIWA-Ar in Alcohol Withdrawal
Detailed physical examination, mental status examination, and planned screening laboratory investigation were done to ensure conformity of study criteria. Patients over 18 years of age were included if they had been admitted to the internal medicine service for a minimum stay of at least 24 h and if there was documentation in the chart of a presumed diagnosis of alcohol withdrawal.
This factor was in accordance to study of Pittman et al. The mean number of fixed-schedule doses received after CIWA-Ar scores were consistently below 10 was 3. Secondly, many other patients were referred from primary care centers with initial management, including long acting benzodiazepines like diazepam that masks the AWS.
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. Materials and Methods 2.
Scree plot, showing three factors above eigenvalue of one and showing ciwa-a inflexion of the ztudy. Whereas clinical variables recorded were age of onset of drinking alcohol, duration of dependence, past history of detoxification, number of previous detoxification, past history of withdrawal seizure, past history of delirium tremens, family history of alcohol or substance dependence, degree of relationship if family history of alcohol or substance dependence is present, and family history of mental illness.
Individualized treatment for alcohol withdrawal.
Hall W, Zador D. Published online Apr 6. Alcohol withdrawal treatment manual.