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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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Arabadjief MA, Elsayed OH, Bashir S, Gundumalla MR, Menefee DS, Bergman CL, Moulana NZ, El-Mallakh RS. Chlordiazepoxide-induced delirium in a patient undergoing alcohol withdrawal: a case report. J Med Case Rep 2022; 16:269. [PMID: 35799217 PMCID: PMC9261023 DOI: 10.1186/s13256-022-03456-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background Ethanol dependence is associated with a discontinuation withdrawal delirium. Chlordiazepoxide is frequently successfully used in its treatment. Case presentation A 27-year-old, Caucasian female with ethanol dependence who had objective symptoms of withdrawal experienced worsening of her delirium after administration of chlordiazepoxide, but improved with lorazepam and cleared with discontinuation of benzodiazepine administration. Conclusions Worsening of delirium appears to be related to the specific use of chlordiazepoxide, but the mechanism of this effect is not clear. While this case does not alter the standard care of ethanol dependence, it does alert clinicians that our treatment approach may not be fully benign.
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Affiliation(s)
- Melissa A Arabadjief
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Omar H Elsayed
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Sabina Bashir
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Meenakshi R Gundumalla
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Derek S Menefee
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Cody L Bergman
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Nayeem Z Moulana
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY, 40241, USA.
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