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Title: Can risk stratification for alcohol withdrawal reduce hospital admissions?
Author: Benson, George
ISNI:       0000 0004 7655 5897
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2018
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Background: This study was necessitated by the number of patients admitted to hospital in the National Health Service Greater Glasgow and Clyde (NHSGGC) area with Alcohol Dependence Syndrome and deemed to be at risk of Severe Alcohol Withdrawal Syndrome (SAWS) and the lack of agreement in the literature on the factors that increased this risk. Aim: To develop an Alcohol Withdrawal Syndrome risk stratification tool that could support staff to safely discharge low risk patients from the emergency department. Methods: There are three stages to this programme of work; case-control; cohort; costing. The case-control study investigated the risk variables from the systematic literature review that were associated with SAWS in the NHSGGC population. 382 case and 382 control patients were randomly selected retrospectively from those referred to the Acute Addiction Liaison Nursing Service (AALNS) during a 12 month period. Statistical significance (p<0.05) and association with Severe Alcohol Withdrawal Syndrome development was calculated using chi-square, Cramer`s V test, Odds Ratio, and Levene`s test. The significant variables were investigated further using a cohort study to identify whether they were correlated with SAWS development in patients referred to the AALNS over one calendar month (n=400). Correlation was calculated using Sprearman`s rank correlation coefficient and multiple regression, while logistic regression determined how well the statistically significant variables predicted SAWS in the cohort population. Finally, the costing study investigated the benefits of implementing the developed risk stratification tool in NHSGGC. Results: Of 13 statistically significant predictors of SAWS, four were retained after binary logistic regression: Glasgow Modified Alcohol Withdrawal Scale < 4, Fast Alcohol Screening Test <15, Systolic Blood Pressure < 138 mmHg at the emergency department and hours since last drink (> 44 hours). These thresholds presented sensitivity for identifying low risk of SAWS at 84.2%, specificity 89%, Negative Predictive Value 86% and Positive Predictive Value 87%. The costing study suggested that the implementation of the risk stratification tool would have financial and bed occupancy benefits to NHSGGC for this population of patients. Conclusion/ Recommendations: The risk stratification tool has excellent predictive value among alcohol dependent patients, and implementing the tool would help clinicians to identify those at low risk of SAWS allowing for prevention of hospital admission and appropriate treatment in the community.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Prof.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available