Hospitalization for Alcohol Withdrawal Syndrome: Burden and Treatment

 描述（由申请人提供）：酒精戒断综合征（AWS）具有显著的发病率和死亡率风险，但尚未在流行病学或治疗学上进行充分研究。在医院环境中，高达40%的患者患有酒精使用障碍， 他们面临开发AWS的风险，但人们对AWS在医院环境中的全国影响知之甚少。很少有研究调查AWS相关住院的患病率，也没有随着时间的推移使用的趋势。在治疗方面，苯二氮卓类药物管理仍然是目前AWS护理的支柱。然而，这种治疗方法的不适当利用和应用很容易在住院设置，促使替代治疗方案，包括抗惊厥药，如苯巴比妥的评价。该项目的目的是确定AWS相关住院的患病率和趋势，同时确定患者和医院层面的结果和利用的决定因素。我们将 使用来自国家住院患者样本（NIS）的2000 - 2012年数据调查这些问题，NIS是一个全付费的全国代表性数据集，每年约有700万人出院。基于这些发现，我们将在Beth Israel Deaconess Medical Center医学ICU进行的准实验性干预中，研究苯巴比妥在重症监护室（ICU）治疗AWS的有效性。我们假设，尽管2000 - 2012年间AWS相关住院率保持稳定，但合并症的负担增加，资源利用成本和结局存在显著差异。我们进一步假设，在AWS重症患者中，基于苯巴比妥的治疗方案将与AWS消退时间缩短以及ICU和住院时间缩短相关。作为博士后研究培训计划的一部分，主要研究者将完成公共卫生硕士学位，专注于临床有效性，以获得必要的流行病学，生物统计学和研究方法学培训，以完成这项工作。这将为全国代表性的卫生服务研究和以地方为基础的有效性评估提供重要的经验，沿着急性酒精的内容教育-相关的病理。该研究项目将在酒精摄入对健康影响领域的一名研究人员的监督和指导下进行，并得到大型数据库分析专家和其他重症监护专家的支持。

 DESCRIPTION (provided by applicant): Alcohol withdrawal syndrome (AWS) carries a significant risk of morbidity and mortality yet has not been well- studied epidemiologically or therapeutically. In the hospital setting, up to 40% of patients have alcohol-use disorders that put them at risk for developing AWS, yet little is known about the national impact of AWS in the hospitalized setting. Few studies have examined the prevalence of AWS-related inpatient admissions nor trends in utilization over time. In terms of treatment, benzodiazepine administration remains the mainstay of current AWS care. However, inappropriate utilization and application of this treatment approach is easy in the inpatient setting, prompting evaluation of alternative treatment options including anticonvulsants such as phenobarbital. The aims of this project are to establish the prevalence and trends in inpatient AWS-related admissions, while also identifying patient- and hospital-level determinants of outcome and utilization. We will investigate these questions using 2000 - 2012 data from the National Inpatient Sample (NIS), an all-payer, nationally-representative dataset with approximately 7 million annual hospital discharges. Building upon these findings, we will then investigate the effectiveness of phenobarbital in treating AWS in the intensive care unit (ICU) in a quasi-experimental intervention conducted in the Beth Israel Deaconess Medical Center medical ICUs. We hypothesize that while AWS-related hospitalizations have remained stable between 2000 - 2012, the burden of comorbidities has increased and significant variability in resource utilization costs, and outcomes exists. We further hypothesize that a phenobarbital-based treatment protocol will be associated with decreased time to resolution of AWS, as well as decreased ICU and hospital length-of-stay, in critically ill patients with AWS. As part of this post-doctoral research training program, the principal investigator will complete a Master of Public Health with a concentration in Clinical Effectiveness to obtain the necessary training in epidemiology, biostatistics, and research methodology to complete this work, which will provide crucial experience in nationally-representative health services research and locally-based effectiveness evaluation along with content education in acute alcohol-related pathologies. This research project will be performed under the supervision and mentorship of an investigator well established in the field of the health effects of alcohol intake, with support from an expert in large database analysis and other experts in critical care.