Screening and Assessment for Unhealthy Alcohol Use Can Determine Hospital Inpatients’ Risk for Alcohol Withdrawal

Screening is intended to identify unhealthy alcohol use for brief intervention, but this study examined whether alcohol screening tools can also stratify hospitalized patients for their risk of alcohol withdrawal syndrome (AWS). In a case-control study of all adult medical or surgical inpatients in one year from a single hospital, investigators identified 223 patients who developed AWS after admission and 500 randomly-selected controls without AWS. All patients had been screened at admission with the Alcohol Use Disorders Identification Test-(Piccinelli) Consumption (AUDIT-PC), which includes five of the ten items from the full AUDIT.

• An AUDIT-PC score of ≥4 proved to be the best cut point between true and false positives for AWS; 9% of cases would be missed.
• For every 17 patients whose screening resulted in a false positive, one was correctly identified as having AWS.
• Among patients who scored ≥4 on the AUDIT-PC, the post-test probability of AWS was 5.8%.

Comments:

This study suggests that a screening questionnaire, the AUDIT-PC, might risk-stratify hospitalized patients for AWS. However, prospective validation with an independent sample is necessary before this tool can be recommended for this purpose. An implication is that even a rudimentary assessment of the alcohol history among inpatients who screen positive for unhealthy drinking can have important clinical and prognostic implications.

Peter D. Friedmann, MD, MPH

Reference:

Pecoraro A, Ewen E, Horton T, et al. Using the AUDIT-PC to Predict Alcohol Withdrawal in Hospitalized Patients. J Gen Intern Med. 2013 [Epub ahead of print]. PMID: 23959745.