Prevalence and Variation of Clinically Recognized Inpatient Alcohol Withdrawal Syndrome in the Veterans Health Administration
| Autor: | Carol A. Malte, Sharukh Lokhandwala, Eric J. Hawkins, Catherine L. Hough, Tessa L. Steel, Katharine A. Bradley |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Specialty Veterans Health 01 natural sciences Article 03 medical and health sciences 0302 clinical medicine Internal medicine Prevalence medicine Humans Pharmacology (medical) 030212 general & internal medicine 0101 mathematics Quality of care Retrospective Studies Inpatients business.industry 010102 general mathematics Retrospective cohort study Veterans health medicine.disease United States Confidence interval Substance Withdrawal Syndrome Psychiatry and Mental health Alcohol withdrawal syndrome Hospital admission Substance use business |
| Zdroj: | J Addict Med |
| ISSN: | 1935-3227 1932-0620 |
| DOI: | 10.1097/adm.0000000000000576 |
| Popis: | Objectives No prior study has evaluated the prevalence or variability of alcohol withdrawal syndrome (AWS) in general hospitals in the United States. Methods This retrospective study used secondary data from the Veterans Health Administration (VHA) to estimate the documented prevalence of clinically recognized AWS among patients engaged in VHA care who were hospitalized during fiscal year 2013. We describe variation in documented inpatient AWS by geographic region, hospital, admitting specialty, and inpatient diagnoses using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and/or procedure codes recorded at hospital admission, transfer, or discharge. Results Among 469,082 eligible hospitalizations, the national prevalence of documented inpatient AWS was 5.8% (95% confidence interval [CI] 5.2%-6.4%), but there was marked variation by geographic region (4.3%-11.2%), hospital (1.4%-16.1%), admitting specialty (0.7%-19.0%), and comorbid diagnoses (1.3%-38.3%). AWS affected a high proportion of psychiatric admissions (19.0%, 95% CI 17.5%-20.4%) versus Medical (4.4%, 95% CI 4.0%-4.8%) or surgical (0.7%, 95% CI 0.6%-0.8%); though by volume, medical admissions represented the majority of hospitalizations complicated by AWS (n = 13,478 medical versus n = 12,305 psychiatric and n = 595 surgical). Clinically recognized AWS was also common during hospitalizations involving other alcohol-related disorders (38.3%, 95% CI 35.8%-40.8%), other substance use conditions (19.3%, 95% CI 17.7%-20.9%), attempted suicide (15.3%, 95% CI 13.0%-17.6%), and liver injury (13.9%, 95% CI 12.6%-15.1%). Conclusions AWS was commonly recognized and documented during VHA hospitalizations in 2013, but varied considerably across inpatient settings. This clinical variation may, in part, reflect differences in quality of care and warrants further, more rigorous investigation. |
| Databáze: | OpenAIRE |
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