Many patients were admitted after overnight, 12 to 18 hours of abstinence, so we included the patients who were admitted with at least 24 hours of abstinence. Author information Copyright and License information Disclaimer. The median duration of benzodiazepine treatment for alcohol withdrawal declined significantly after introduction of the combination protocol: We had additional anxiety to this factor; hence, we share the name of this factor with Pittman et al. Using numbers derived from an unpublished study conducted at another local hospital by one of the investigators where mean withdrawal duration was 80 h for the pre-intervention group and 50 h for the post-intervention group, for a h difference, with standard deviation [SD] of 55 h , we calculated a required sample size of

This suggests that ratings on alcohol withdrawal symptoms on the very first day may miss certain set of symptoms, which appears on and around day two and are characterized by perceptual abnormality and delirium like picture. Fixed-schedule dosing may have functioned as a type of buffer: None of the items loaded on more than one factor. The primary outcome was the duration of benzodiazepine treatment for alcohol withdrawal, defined as the time difference in hours between the first and last doses given in hospital, including doses given in the emergency department. This study has demonstrated that a protocol combining fixed-schedule and symptom-triggered dosing can also yield benefit and may serve as an alternative to protocols based on symptom-triggered dosing alone, although it is recognized that improvements in outcome may be more limited with the combined approach.

Multidimensionality of the Alcohol Withdrawal Symptom Checklist: Strength of our study includes large sample size and not interfering with any medications or management strategies thus providing setting of naturalistic conditions.

Hesitation in trusting exclusively symptom-triggered ciwq-ar may stem from lack of staff who are trained and familiar with stufy CIWA-Ar—based alcohol withdrawal protocol. Kaiser’s criterion [ 13 ] to retain eigenvalues greater than unity and Cattell’s [ 14 ] scree plot inspection for the point of inflexion.


Can J Hosp Pharm. Further studies may also be carried out including cases of mild to moderate severity and in both sex to uncover the differences. This article has been cited by ciwz-ar articles in PMC. The chart review nature of this study introduced innate limitations in terms of potential bias and missing data.

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

A chart review of admissions to the internal medicine service for alcohol withdrawal was conducted to compare treatment outcomes before October to April and after October to April implementation of the combination protocol. Many patients were admitted after overnight, 12 to 18 hours of abstinence, so we included the patients who were admitted with at least 24 hours ciw-ar abstinence. Implementation in at least the emergency department would help to reduce the delay in initiating the protocol for individual patients and might therefore further increase the benefits observed with the protocol.

Admission with seizure or xiwa-ar disorder unrelated to alcohol ciwa-ad. Received Oct 15; Accepted Mar A three-factor solution was obtained that accounted for It is the most widely used and studied item alcohol withdrawal monitoring scale, which excludes vital sign abnormalities.

We evaluated the median length of time for the various steps leading to eventual administration of the alcohol withdrawal protocol Table 5. The standard detoxification protocol included thiamine casw, benzodiazepines either lorazepam or diazepam, and correction of fluids and electrolytes if any and other symptomatic treatment of associated conditions like dyspepsia or concurrent injury, wound, and infections.

ciwa-ar case study

Of the admissions reviewed, were included after application of the inclusion and exclusion criteria Table 1. Meanwhile management and medications were continued as per ward protocol and no adjustment for study purpose was done. The authors report no conflict of interests. The difference may be due to the time span of withdrawal on which data was collected.


No other benzodiazepines were used in the post-protocol group, but in the pre-protocol group, clonazepam was given in 2 admissions and midazolam in 1 admission. This was expected as alcohol withdrawal manifests by simultaneous involvement of all mechanisms rather than any mutually exclusive mechanism.

Likewise, for patients with comorbidities being treated in general hospital wards, symptom-triggered dosing regimens resulted in lower incidence of delirium tremens, shorter duration of benzodiazepine treatment, 8 and a lower total benzodiazepine dose. Median duration of benzodiazepine therapy IQR h.

ciwa-ar case study

Family history of mental illness included affective disorder in 9. We designed our study to show a difference as small as 30 h because the protocol used a combination of fixed-dose and symptom-triggered dosing and may have led to a smaller improvement in treatment duration.

British Journal of Psychiatry.

Alcohol withdrawal treatment manual. Introduction Alcohol withdrawal syndrome AWS is characterized by varied symptoms that range from mild to severe intensity depending on several factors including the quantity, frequency and duration of alcohol intake, and the number of prior withdrawal episodes, as well as individual differences in the vulnerability [ 1 — 4 ].

Factor Structure of CIWA-Ar in Alcohol Withdrawal

The CIWA-Ar protocol dictates the period for which monitoring is required and whether a benzodiazepine dose should be administered.

Specialized education in using the CIWA-Ar protocol was organized for nursing staff, and pharmacy and medical staff were notified of initiation of the preprinted order. Author information Copyright and License information Disclaimer.

ciwa-ar case study

Another limitation of this study is patients sample with severe AWS requiring inpatient management, thus limiting generalizability of our findings across gender and to mild to moderate severity cases. Open in a separate window.