{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T10:29:55Z","timestamp":1773052195398,"version":"3.50.1"},"reference-count":16,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Emerg Med J"],"accepted":{"date-parts":[[2018,9,4]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>We previously reported that benzodiazepine detoxification for alcohol withdrawal using symptom-triggered therapy (STT) with oral diazepam reduced length of stay (LOS) and cumulative benzodiazepine dose by comparison with standard fixed-dose regimen. In this study, we aim to describe the feasibility of STT in an emergency department (ED) short-stay clinical decision unit (CDU) setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective cohort study, we describe our experience with STT over a full calendar year (2014) in the CDU. A retrospective chart review was conducted and data collection included demographics, clinical details, total cumulative dose of diazepam, receipt of parenteral thiamine, LOS and disposition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>5% (n=174) of 3222 admissions to CDU required STT. Collapse or seizure (41%, n=71) and alcohol withdrawal (21%, n=37) were the most common reasons recorded for admission to CDU in those who required STT. Median Alcohol Use Disorders Identification Test score was 25 and 112 patients (64%) had at least one Clinical Institute Withdrawal Assessment for Alcohol revised measurement \u226510, triggering a dose of diazepam (20\u2009mg). The median cumulative oral diazepam dose was 20\u2009mg while 24 (15%) patients received a cumulative dose of 100\u2009mg or more. Median time for STT was 12\u2009hours (IQR=12, R=1\u201348). 3% (n=5) of patients required further general hospital admission and median LOS in CDU, was 22\u2009hours (IQR=20, R=1\u2013168).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>STT is potentially feasible as a rapid and effective approach to managing alcohol withdrawal syndrome in the ED\/CDU short-stay inpatient setting where patient LOS is generally less than 24\u2009hours.<\/jats:p><\/jats:sec>","DOI":"10.1136\/emermed-2017-206997","type":"journal-article","created":{"date-parts":[[2018,10,3]],"date-time":"2018-10-03T16:39:53Z","timestamp":1538584793000},"page":"18-21","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit"],"prefix":"10.1136","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7019-2146","authenticated-orcid":false,"given":"Muhammad Fahmi","family":"Ismail","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kieran","family":"Doherty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Bradshaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iomhar","family":"O\u2019Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene M","family":"Cassidy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,10,3]]},"reference":[{"key":"2024052702051859000_36.1.18.1","first-page":"1","article-title":"Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies","volume":"17","author":"Yanta","year":"2015","journal-title":"Emerg Med Pract"},{"key":"2024052702051859000_36.1.18.2","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.ajem.2017.02.002","article-title":"The emergency medicine management of severe alcohol withdrawal","volume":"35","author":"Long","year":"2017","journal-title":"Am J Emerg Med"},{"key":"2024052702051859000_36.1.18.3","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2011-200509"},{"key":"2024052702051859000_36.1.18.4","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1055\/s-0042-104508","article-title":"Assessment of pharmacological treatment quality: Comparison of symptom-triggered vs. Fixed-schedule alcohol withdrawal in clinical practice","volume":"49","author":"M\u00fcller","year":"2016","journal-title":"Pharmacopsychiatry"},{"key":"2024052702051859000_36.1.18.5","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agt181"},{"key":"2024052702051859000_36.1.18.6","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.10.1117"},{"key":"2024052702051859000_36.1.18.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520070039035"},{"key":"2024052702051859000_36.1.18.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2004.00822.x"},{"key":"2024052702051859000_36.1.18.9","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1192\/pb.28.11.407","article-title":"Evaluation of a symptom-triggered front-loading detoxification technique for alcohol dependence: A pilot study","volume":"28","author":"Day","year":"2004","journal-title":"Psychiatr Bull"},{"key":"2024052702051859000_36.1.18.10","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2004.017236"},{"key":"2024052702051859000_36.1.18.11","first-page":"211","article-title":"Diazepam loading in alcohol withdrawal: clinical pharmacokinetics","volume":"28","author":"Hein\u00e4l\u00e4","year":"1990","journal-title":"Int J Clin Pharmacol Ther Toxicol"},{"key":"2024052702051859000_36.1.18.12","first-page":"CD004033","article-title":"Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol","volume":"7","author":"Day","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2024052702051859000_36.1.18.13","unstructured":"National Clinical Guideline Centre (UK). 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