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Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit
  1. Muhammad Fahmi Ismail1,
  2. Kieran Doherty1,
  3. Paula Bradshaw1,
  4. Iomhar O’Sullivan2,
  5. Eugene M Cassidy3
  1. 1 Department of Liaison Psychiatry, Cork University Hospital Group, Wilton, Ireland
  2. 2 Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
  3. 3 Department of Psychiatry and Neurobehavioural Science, University College Cork National University of Ireland, Wilton, Ireland
  1. Correspondence to Professor Eugene M Cassidy, Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland; eugene.cassidy{at}


Introduction We previously reported that benzodiazepine detoxification for alcohol withdrawal using symptom-triggered therapy (STT) with oral diazepam reduced length of stay (LOS) and cumulative benzodiazepine dose by comparison with standard fixed-dose regimen. In this study, we aim to describe the feasibility of STT in an emergency department (ED) short-stay clinical decision unit (CDU) setting.

Methods In this retrospective cohort study, we describe our experience with STT over a full calendar year (2014) in the CDU. A retrospective chart review was conducted and data collection included demographics, clinical details, total cumulative dose of diazepam, receipt of parenteral thiamine, LOS and disposition.

Results 5% (n=174) of 3222 admissions to CDU required STT. Collapse or seizure (41%, n=71) and alcohol withdrawal (21%, n=37) were the most common reasons recorded for admission to CDU in those who required STT. Median Alcohol Use Disorders Identification Test score was 25 and 112 patients (64%) had at least one Clinical Institute Withdrawal Assessment for Alcohol revised measurement ≥10, triggering a dose of diazepam (20 mg). The median cumulative oral diazepam dose was 20 mg while 24 (15%) patients received a cumulative dose of 100 mg or more. Median time for STT was 12 hours (IQR=12, R=1–48). 3% (n=5) of patients required further general hospital admission and median LOS in CDU, was 22 hours (IQR=20, R=1–168).

Conclusion STT is potentially feasible as a rapid and effective approach to managing alcohol withdrawal syndrome in the ED/CDU short-stay inpatient setting where patient LOS is generally less than 24 hours.

  • mental health, alcohol abuse
  • alcohol abuse
  • emergency department management

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  • Contributors MFI, KD, EMC, PB and IOS were involved in the planning of the study. MFI and KD conducted the data collection and MFI has completed the data analysis. MFI and EMC were responsible in preparing the manuscript. MFI, KD, EMC, PB and IOS were involved in the revision of the manuscript. All authors certify that they have participated sufficiently in the work to take public responsibility for the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.