Citation

Carter W, Truong P, Sima AP, Hupe J, Newman J, Ebadi A. PM R 2020; ePub(ePub): ePub.

Affiliation

Undergraduate, Virginia Commonwealth University, Richmond, Virginia, USA.

Copyright

(Copyright © 2020, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI

10.1002/pmrj.12385

PMID

32304351

Abstract

INTRODUCTION: Alcohol withdrawal syndrome (AWS) and traumatic brain injury (TBI) present with similar signs and symptoms, yet their treatment strategies differ greatly. AWS treatment includes the Clinical Institute Withdrawal Assessment (CIWA) protocol, which grades withdrawal signs and symptoms. A major purpose of CIWA is to guide the addition and titration of central nervous system (CNS) depressants, most commonly benzodiazepines. Conversely, best practice is to avoid these same CNS depressants in the setting of TBI. Thus, patients with TBI presenting with AWS risk may receive undesirable interventions that could worsen outcome.

OBJECTIVE: To describe the relationship of TBI diagnosis with CIWA protocol scores and intervention implementation.

DESIGN: Retrospective cohort observational study. SETTING: Single university-based, level one trauma center. PATIENTS: Three hundred and seventy-five patients with head trauma or AWS classification, identified through the trauma center's trauma registry. INTERVENTIONS: CIWA protocol and related medication use. MAIN OUTCOME MEASURES: Frequency of elevated CIWA score, length of CIWA administration, and medication administration incidence were abstracted from patients' medical records.

RESULTS: The percentage of elevated CIWA scores increased significantly with TBI severity, from 4.5%[0-60] in the No TBI group, up to 12.5%[0-36] in the Mild TBI group, 27.1%[0-57] in the Moderate TBI group, and 50.0%[14-77] in the Severe TBI group. Nominally, lorazepam use showed a similar pattern of escalation with TBI severity, but it did not reach statistical significance. Haloperidol use did significantly escalate with higher TBI severity. No group differences were observed for total lorazepam equivalents or length on the CIWA protocol.

CONCLUSIONS: TBI diagnosis and higher TBI severity level correlates with higher CIWA scores, but we observed neither increased nor decreased benzodiazepine usage. Antipsychotic use did escalate with TBI diagnosis and severity. The risks vs benefits of minimizing benzodiazepines in patients with TBI who are at risk for AWS warrants future study. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en