Development of an Alcohol Withdrawal risk stratification tool based on patients referred to an addiction liaison nursing service in Glasgow

George Benson, Andrew McPherson, Jacqueline McCallum, Nicola Roberts

Research output: Contribution to journalArticle

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Abstract

Purpose: The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department. Design/methodology/approach: A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population. Findings: The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively. Research limitations/implications: The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score. Practical implications: The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life. Originality/value: The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.
Original languageEnglish
JournalDrugs and Alcohol today
DOIs
Publication statusPublished - 10 Jun 2019

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Nursing Services
Alcohols
Life Support Care
Hospital Emergency Service
Social Welfare
Alcoholism
Psychology
Blood Pressure
Research
Patient Care
Cohort Studies
Retrospective Studies

Keywords

  • Alcohol
  • Alcohol withdrawal syndrome
  • Alcohol-related seizures
  • Delirium tremens
  • General hospital
  • Hospital admission
  • Risk prediction
  • Risk stratification

Cite this

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title = "Development of an Alcohol Withdrawal risk stratification tool based on patients referred to an addiction liaison nursing service in Glasgow",
abstract = "Purpose: The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department. Design/methodology/approach: A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population. Findings: The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95{\%} CI 2.21, 3.45), 1.31 (95{\%} CI 1.24, 1.37), 1.30 (95{\%} CI 1.08, 1.57) and 1.22 (95{\%} CI 1.10, 1.34), respectively. Research limitations/implications: The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score. Practical implications: The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life. Originality/value: The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.",
keywords = "Alcohol, Alcohol withdrawal syndrome, Alcohol-related seizures, Delirium tremens, General hospital, Hospital admission, Risk prediction, Risk stratification",
author = "George Benson and Andrew McPherson and Jacqueline McCallum and Nicola Roberts",
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Development of an Alcohol Withdrawal risk stratification tool based on patients referred to an addiction liaison nursing service in Glasgow. / Benson, George; McPherson, Andrew; McCallum, Jacqueline; Roberts, Nicola.

In: Drugs and Alcohol today, 10.06.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Development of an Alcohol Withdrawal risk stratification tool based on patients referred to an addiction liaison nursing service in Glasgow

AU - Benson, George

AU - McPherson, Andrew

AU - McCallum, Jacqueline

AU - Roberts, Nicola

N1 - Acceptance in SAN AAM version queried 30/04/19 DC; author highlighted point in publisher email where they consider the attached the AAM. ET 1/5/19 AAM: no embargo upon publication Added pre-pub embargo end date. ET 30/10/19

PY - 2019/6/10

Y1 - 2019/6/10

N2 - Purpose: The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department. Design/methodology/approach: A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population. Findings: The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively. Research limitations/implications: The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score. Practical implications: The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life. Originality/value: The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.

AB - Purpose: The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department. Design/methodology/approach: A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population. Findings: The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively. Research limitations/implications: The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score. Practical implications: The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life. Originality/value: The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.

KW - Alcohol

KW - Alcohol withdrawal syndrome

KW - Alcohol-related seizures

KW - Delirium tremens

KW - General hospital

KW - Hospital admission

KW - Risk prediction

KW - Risk stratification

U2 - 10.1108/DAT-02-2019-0009

DO - 10.1108/DAT-02-2019-0009

M3 - Article

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