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Alcohol Withdrawal Syndrome: Turning Minor Injuries Into a Major Problem

Bard, Michael R. MD, FACS; Goettler, Claudia E. MD, FACS; Toschlog, Eric A. MD, FACS; Sagraves, Scott G. MD, FACS; Schenarts, Paul J. MD, FACS; Newell, Mark A. MD, FACS; Fugate, Mark MD; Rotondo, Michael F. MD, FACS

Journal of Trauma and Acute Care Surgery: December 2006 - Volume 61 - Issue 6 - p 1441-1446
doi: 10.1097/01.ta.0000245981.22931.43
Original Articles

Background: Abrupt cessation of chronic drinking patterns places hospitalized patients at risk for alcohol withdrawal syndrome (AWS). The purpose of this study was to investigate the effect of AWS on length of stay, morbidity, mortality, and cost in low injury acuity trauma patients.

Methods: A retrospective review of the National Trauma Registry of the American College of Surgeons database from July 1999 to February 2004 was performed. All patients 15 years or older admitted to our Level I trauma center with an Injury Severity Score (ISS) <16 were included. AWS patients were compared with those without AWS. Demographics, mechanism of injury (MOI), ISS, revised trauma score, Glasgow Coma score, hospital course, morbidity, requirement of additional procedures, mortality, and cost were compared. Analysis was done with χ2 test and Student’s t test. A p value of ≤0.05 determined significance.

Results: Of 6,431 patients, 55 (0.9%) developed AWS. AWS patients were likely men (p < 0.001); had a higher ISS (p = 0.001) and lower Glasgow Coma score (p = 0.01); had more ventilator days (p = 0.008), intensive care unit days (p < 0.0001), and hospital days (p < 0.0001); suffered more complications, including respiratory failure (p < 0.0001), pneumonia (p < 0.0001), urinary tract infection (p = 0.0005), sepsis (p < 0.0001), tracheostomy (p < 0.0001), and percutaneous endoscopic gastrostomy (p < 0.0001); and had higher cost (p < 0.0001). Mortality was similar (p = 0.38) among groups.

Conclusions: Low injury acuity patients with AWS have increased morbidity, leading to increased hospital stay and cost. To allow minor injuries to remain minor problems, the best modality to identify patients at risk and to achieve AWS prophylaxis require further investigation.

From the Department of Surgery, The Brody School of Medicine, East Carolina University, and The Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville, North Carolina.

Submitted for publication July 27, 2005.

Accepted for publication September 5, 2006.

Presented at the 18th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 12–15, 2005, Fort Lauderdale, FL.

Address for reprints: Michael R. Bard, MD, Assistant Professor, Department of Surgery, Brody School of Medicine, East Carolina University, University Health Care Systems of Eastern Carolina, 600 Moye Boulevard, Greenville, NC 27858-4354, 252.847.8710 (office), 252.847.8208 (fax); email:

© 2006 Lippincott Williams & Wilkins, Inc.