1801: Patient-Specific Markers Associated with the Risk of Alcohol Withdrawal in the Trauma Population

Abstract

Learning Objectives: Alcohol withdrawal syndrome (AWS) and delirium tremens (DTs) have been reported as a complication following traumatic injury, at rates of 0.88% and 0.10%, respectively. AWS among trauma patients is associated with an increased length of hospital stay, mechanical ventilation, and aspiration pneumonia. There is minimal literature about the optimal screening tool to predict and stratify trauma patients at risk for AWS. Additionally, there has been increased interest in the use of phenobarbital as a management strategy for AWS. The purpose of this systematic review were to evaluate screening tools to identify trauma patients who are most likely to develop AWS, and assess phenobarbital dosing strategies for prophylaxis of AWS. Methods: A literature search was performed in PubMed/MEDLINE. The initial search yielded 1072 articles from which non-English and duplicate articles were removed. The remaining 974 articles underwent blinded review with an interprofessional team. Twenty articles were included in the final analysis. These studies were assessed for level of evidence using the Grading of Recommendations Assessment, Development and Evaluation tool (GRADE). Results: Twenty articles were included in the final analysis with eleven reviewing tools and nine reviewing phenobarbital dosing strategies. CAGE and brief MAST were the most commonly used questionnaires for adults with blunt or penetrating trauma. Other factors associated with the development of AWS and DTs include male gender, age, and blood alcohol level. Laboratory biomarkers such as elevated AST and MCV are associated with alcohol use among trauma victims. While phenobarbital has been evaluated for management of AWS and DTs, none of the studies utilized phenobarbital in the prevention of AWS or DTs. Conclusions: Further investigation into the predictive ability of a screening tool that combines a short questionnaire, laboratory values, and patient demographics to predict and stratify the risk of AWS and DTs in the adult trauma population is warranted. Additional research is needed to identify pharmacologic strategies for prophylaxis of AWS and DTs.