Risk for delirium tremens in patients with alcohol withdrawal syndrome 1 |
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Authors: | David A Fiellin MD Patrick G O'Connor MD MPH Eric S Holmboe MD Ralph I Horwitz MD |
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Institution: | 1. Department of Internal Medicine , Yale University School of Medicine , New Haven, Connecticut;2. Robert Wood Johnson Clinical Scholars Program , Yale University School of Medicine , New Haven, Connecticut;3. Yale University School of Medicine , 333 Cedar Street, P.O. Box 208025, New Haven, Connecticut, 06520–8025 E-mail: david.fiellin@yale.edu;4. Robert Wood Johnson Clinical Scholars Program , Yale University School of Medicine , New Haven, Connecticut |
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Abstract: | To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case‐control study at the detoxification units of two hospitals. Cases met DSM‐IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to report a prior complicated withdrawal (DT or alcohol withdrawal seizure) (53 vs. 27%, OR 3.1, 95% CI 0.94–10.55), have a systolic blood pressure greater than 145 mm Hg on admission (60 vs. 27%, OR 4.1, 95% CI 1.21–14.06), and have comorbidity scores of at least 1 (60 vs. 18%, OR 6.9, 95% CI 1.92–25.08). Zero cases (0%) and 15 (33%) controls had no prior complicated withdrawals and no adverse clinical features (systolic blood pressure >145 or comorbidity score >1). Compared to this group, the odds of being a case and having both prior complicated withdrawal and at least 1 adverse clinical feature was 44.8 (95% CI4.36–460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens. |
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Keywords: | alcohol withdrawal delirium delirium tremens substance withdrawal syndrome case‐control studies prognosis comorbidity |
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