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Suárez-Cuenca JA, Toledo-Lozano CG, Espinosa-Arroyo MD, Vázquez-Aguirre NA, Fonseca-González GT, Garro-Almendaro K, Melchor-López A, García-López VH, Ortiz-Matamoros A, Ortega-Rosas T, Alcaraz-Estrada SL, Mondragón-Terán P, García S. Diagnostic Performance of AST Scale in Mexican Male Population for Alcohol Withdrawal Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159208. [PMID: 35954565 PMCID: PMC9367724 DOI: 10.3390/ijerph19159208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Alcohol withdrawal syndrome (AWS) represents an adverse consequence of chronic alcohol use that may lead to serious complications. Therefore, AWS requires timely attention based on its early recognition, where easy-to-apply diagnostic tools are desirable. Our aim was to characterize the performance of a short-scale AST (Anxiety, Sweats, Tremors) in patients from public general hospitals. We conducted a cross-sectional study of patients attended at the Emergency Department diagnosed with AWS. Three scales were applied: CIWA-Ar (Clinical Institute Retirement Assessment Scale-Revised), GMAWS (Glasgow Modified Alcohol Withdrawal Syndrome) and AST. Cronbach’s alpha and Cohen’s kappa tests were used for reliability and concordance. Factorial analysis and diagnostic performance including ROC curve were carried out. Sixty-eight males with a mean age of 41.2 years old, with high school education and robust alcohol consumption, were included. Mean scores for CIWA-Ar, GMWAS and AST were 17.4 ± 11.2, 3.9 ± 2.3 and 3.8 ± 2.6, respectively, without significant differences. The AST scale showed an acceptable reliability and concordance (0.852 and 0.439; p < 0.0001) compared with CIWA-Ar and GMAWS. AST component analysis evidenced tremor (77.5% variance), sweat (12.1% variance) and anxiety (10.4% variance). Diagnostic performance of the AST scale was similar to the GMAWS scale, evidencing a sensitivity of 84%, specificity of 83.3% and Area Under the Curve (AUC) of 0.837 to discriminate severe AWS, according to CIWA-Ar. The performance of the AST scale to evaluate AWS is comparable with the commonly used CIWA-Ar and GMAWS scales. AST further represents an easy-to-apply instrument.
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Affiliation(s)
- Juan Antonio Suárez-Cuenca
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | - Christian Gabriel Toledo-Lozano
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-551-956-2089 (C.G.T.-L.); +52-555-437-7491 (S.G.)
| | - Maryjose Daniela Espinosa-Arroyo
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | - Nallely Alejandra Vázquez-Aguirre
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | | | - Karen Garro-Almendaro
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | - Alberto Melchor-López
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | | | - Abril Ortiz-Matamoros
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | - Tania Ortega-Rosas
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | | | - Paul Mondragón-Terán
- Coordination of Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico;
| | - Silvia García
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-551-956-2089 (C.G.T.-L.); +52-555-437-7491 (S.G.)
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Noë B, Bullock A, Frankish J, Turner LD. Temporal patterns in vital sign recording within and across general hospital wards. Resusc Plus 2022; 10:100247. [PMID: 35620181 PMCID: PMC9127396 DOI: 10.1016/j.resplu.2022.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/05/2022] [Accepted: 04/30/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The use of mobile devices on hospital wards to record patient vital signs and Early Warning Scores provides opportunity for secondary analysis of the data collected. This research investigated how such analysis can contribute to the understanding of the complexities of managing clinical care in hospital environments. Methods The influence of ward type and the distribution of patient observation intervals was evaluated in relation to the timing of vital signs observation patterns in data collected from eight adult in-patient wards over a 12-month period. Actual and projected observation times were compared across patients with higher and lower National Early Warning Scores (NEWS). Results Both ward type and the distribution of patient observation intervals were significant predictors of temporal observation patterns. Observation patterns showed evidence of grouping of observation recordings. This was, however, not found for observations of patients with higher NEWS scores (3 or more). Conclusions Secondary analysis of vital signs observation data can reveal insights into how ward operate. The patterns of observation recordings within a ward are a reflection of ward type and the distribution of patient observation intervals. The grouping of observation recordings of patients with low NEWS (<3) result in late or early observations to fit activity peaks characteristic of the ward culture.
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Affiliation(s)
- Beryl Noë
- School of Computer Science and Informatics, Cardiff University, UK
- Corresponding author.
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, UK
| | - John Frankish
- Informatics Directorate, Aneurin Bevan University Health Board, UK
| | - Liam D. Turner
- School of Computer Science and Informatics, Cardiff University, UK
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Abstract
BACKGROUND The literature lacks consensus to the factors that increase the risk of a patient developing severe alcohol withdrawal syndrome (SAWS). AIM The study set out to identify the variables that increase the risk of SAWS in patients who have alcohol dependence syndrome. METHODS A case-control study was designed to investigate the variables associated with SAWS in an acute hospital setting. Three hundred eighty-two case and 382 control patients were randomly selected retrospectively from referrals to the acute addiction liaison nursing service during a 12-month period (January 1, 2015, to December 31, 2015). Statistical significance (p < .05) and association with SAWS were calculated using chi-square, Cramer's V test, odds ratio, and Levene's test. RESULTS Twenty-four variables have been identified as associated with SAWS development. Five of the 24 variables had a moderate-to-strong association with SAWS risk: Fast Alcohol Screening Test, Glasgow Modified Alcohol Withdrawal Scale score, AWS admission, hours since the last drink, and systolic blood pressure. The study also identified that comorbidity was associated with not developing SAWS. CONCLUSION/RECOMMENDATIONS These findings confirm that noninvasive variables collected in the emergency department are useful in identifying a person's risk of developing SAWS. The results of this study are a useful starting point in the exploration of SAWS and the development of a tool for use in the emergency department that can stratify risk into high and low and is the next stage of this program of work.
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Benson G, Roberts N, McCallum J, McPherson A. Severe alcohol withdrawal syndrome: review of the literature. DRUGS AND ALCOHOL TODAY 2019. [DOI: 10.1108/dat-10-2018-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to identify published literature from a general hospital setting that may highlight variables implicated in the development of severe alcohol withdrawal syndrome (SAWS) in patients who have alcohol dependence syndrome (ADS).
Design/methodology/approach
A systematic literature review was carried out using the electronic databases: MEDLINE, Medline in Process, Cinahl, Embase and PsycINFO from 1989 to 2017. The focus of this search was on English language studies of individuals over 16 years admitted to general hospital with ADS, delirium tremens (DTs), alcohol-related seizure (ARS) or alcohol withdrawal syndrome (AWS).
Findings
Of the 205 studies screened, eight met the criteria for inclusion. Six studies were quantitative retrospective cohort and two were retrospective case-control. Six studies investigated risk factors associated with DTs, one examined SAWS and one alcohol kindling. Descriptive analysis was performed to summarise the empirical evidence from studies were 22 statistically significant risk factors were found; including the reason for admission to hospital, daily alcohol consumption, previous DTs and prior ARS. The last two factors mentioned appeared in two studies.
Research limitations/implications
Further research should consider the quality and completeness of the alcohol history data and competence of staff generating the data in retrospective studies.
Originality/value
The paper suggests that the factors linked to SAWS development from the literature may not fully explain why some individuals who have ADS develop SAWS, and others do not.
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McPherson A, Benson G, Forrest EH. Appraisal of the Glasgow assessment and management of alcohol guideline: a comprehensive alcohol management protocol for use in general hospitals. QJM 2012; 105:649-56. [PMID: 22328545 DOI: 10.1093/qjmed/hcs020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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. AIM To determine if this alcohol assessment guideline aids the management of AWS in general hospitals. DESIGN 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. CONCLUSION 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.
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Affiliation(s)
- A McPherson
- Acute Addiction Liaison Team, Glasgow Addiction Services, Legal House, 101 Gorbals Street, Glasgow, G5 9DW, UK.
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