Article

Substance Abuse

, Volume 23, Issue 2, pp 83-94

Risk for Delirium Tremens in Patients with Alcohol Withdrawal Syndrome

  • David A. FiellinAffiliated withDepartment of Internal Medicine, Yale University School of MedicineRobert Wood Johnson Clinical Scholars Program, Yale University School of Medicine
  • , Patrick G. O'ConnorAffiliated withDepartment of Internal Medicine, Yale University School of Medicine
  • , Eric S. HolmboeAffiliated withDepartment of Internal Medicine, Yale University School of MedicineRobert Wood Johnson Clinical Scholars Program, Yale University School of Medicine
  • , Ralph I. HorwitzAffiliated withDepartment of Internal Medicine, Yale University School of MedicineRobert Wood Johnson Clinical Scholars Program, Yale University School of Medicine

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Abstract

To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case-control study at the detoxification units of two hospitals. Cases met DSM-IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to report a prior complicated withdrawal (DT or alcohol withdrawal seizure) (53 vs. 27%, OR 3.1, 95% CI 0.94–10.55), have a systolic blood pressure greater than 145 mm Hg on admission (60 vs. 27%, OR 4.1, 95% CI 1.21–14.06), and have comorbidity scores of at least 1 (60 vs. 18%, OR 6.9, 95% CI 1.92–25.08). Zero cases (0%) and 15 (33%) controls had no prior complicated withdrawals and no adverse clinical features (systolic blood pressure >145 or comorbidity score >1). Compared to this group, the odds of being a case and having both prior complicated withdrawal and at least 1 adverse clinical feature was 44.8 (95% CI 4.36–460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens.

alcohol withdrawal delirium delirium tremens substance withdrawal syndrome case-control studies prognosis comorbidity