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J Addict Med. 2019 Oct 11. doi: 10.1097/ADM.0000000000000576. [Epub ahead of print]

Prevalence and Variation of Clinically Recognized Inpatient Alcohol Withdrawal Syndrome in the Veterans Health Administration.

Author information

1
University of Washington, Division of Pulmonary, Critical Care, & Sleep Medicine, Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle Division, Seattle, WA (TLS); Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle Division, Seattle, WA (CAM); Kaiser Permanente Washington Health Research Institute, Seattle, WA (KAB); University of Washington, Division of Pulmonary, Critical Care, & Sleep Medicine, Harborview Medical Center, Seattle, WA (SL, CLH); Center of Excellence in Substance Addiction Treatment and Education Seattle-Denver Center of Innovation (COIN), University of Washington, Department of Psychiatry and Behavioral Sciences, VA Puget Sound Health Care System, Seattle Division, Seattle, WA (EJH).

Abstract

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.

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