Clinical predictors for delirium tremens in alcohol dependence

Abstract

A simple assessment using the past history of DT and the pulse rate, which may be easily evaluated in clinical settings, can allow physicians to readily identify the patients who are at a high risk of developing DT during an alcohol dependence period and reserve more intensive therapies for the selected cases.

Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

“…6,7,10 . Two studies are retrospective, utilize hospitalized medical patients, and have conflicting results.…”

“…In the second study, 33 % of patients developed DTs; HR> 100 and a history of prior DTs were the strongest predictor variables. 7 The one identified prospective study examined risk factors for DTs among patients requesting alcohol detoxification. 10 Of these patients, 43.5 % had prior DTs and 41.6 % had prior seizures.…”

“…4,5 Predictors of DTs, however, are generally derived from retrospective studies of hospitalized medical patients, and may not apply to patients presenting to the emergency department for detoxification. 6,7 The University of North Carolina (UNC) Health Care System includes a 805-bed academic hospital, with 38,000 admissions and 73,000 emergency department (ED) visits annually (http:// www.unchealthcare.org/site/aboutus/fiscal_facts.htm). The UNC internal medicine hospitalist practice admits an average of 19 patients per month for detoxification from alcohol.…”

Alcohol withdrawal delirium - diagnosis, course and treatment

“…Other reviews showed the expectation of experiencing withdrawal delirium to be 4-15% for alcoholdependent individuals 21,22 . Delirium develops in 5-20% of patients treated for alcohol withdrawal syndrome 10,11,23,24 , with the rates varying from study to study from 1.25% to 33%.…”

“…Without proper management, mortality may range from 5% to 15% or even 20% (ref. 23,39 ). When treated appropriately (benzodiazepines) and detected early, the mortality should not exceed 1% (ref.…”