WITHDRAWAL ASSESSMENT FOR ALCOHOL WITHDRAWAL AND COMORBID TRAUMATIC BRAIN INJURY
Cheever, Chong (Sherry)
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Each year, the incidence of traumatic brain injuries (TBI) in the United States is reported to be ~1.7 million total cases with approximately 50% of all those cases being related to alcohol consumption. The medical staff during intake to the Neurosurgical Intensive Care Unit (NICU) using the Clinical Institute’s Withdrawal Assessment tool are challenged to differentiate the symptoms related to alcohol withdrawal to those of an acute phase TBI. This study is to test the validity of the CIWA-Ar tool in use on TBI patients testing alcohol positive to those testing alcohol negative upon intake to the Neuro ICU. The study at a Western United States level-one Trauma hospital employed a retrospective two-group comparison design (alcohol positive, alcohol negative) with measurements obtained one to three consecutive days for group comparisons of CIWA-Ar total and CIWA-Ar 10 individual item scores. Patient data for 124 participants: alcohol positive (n= 31) and alcohol negative (n=84), were collected across the two TBI alcohol groups. Multiple Linear Regression results of the CIWA-Ar total mean score showed that the alcohol group membership (= 0.21, p = 0.03) significantly predicted the mean CIWA-Ar total score for alcohol positive participants when controlled for age and gender. When examining each CIWA-Ar item, only CIWA-Ar item 2 (tremors) was predicted by alcohol ( = 0.29, p =0.03) and age ( = 0.21, p =0.03), where TBI alcohol-positive participants and older participants had higher CIWA-Ar 2 scores. The results of the exploratory aim showed that having a frontal contusion had significantly different scores on agitation, traumatic subarachnoid hemorrhage for paroxysmal sweats, and intraparenchymal hemorrhage for nausea / vomiting, agitation, and headache / fullness in head in comparison to the other types of TBI encountered. Results of the analysis showed the importance in the clinical setting to require prior alcohol testing and administration of a substance withdrawal protocol at the NICU to enhance the specificity of the patients’ treatment plan. Proper identification of symptoms at this crucial time is critical for positive patient outcomes. This study provides a foundation that warrants further research to develop a specific CIWA-TBI tool.