Hospital management of alcohol withdrawal: elective versus unplanned admission and detoxification

Patients presenting to hospital with unplanned alcohol withdrawal in the United Kingdom are frequently admitted and managed with a fixed-dose benzodiazepine detoxification regimen. The West Midlands Poisons Unit (WMPU) offers an alternative to this with rapid supported discharge and subsequent elective inpatient detoxification, based on a symptom-triggered approach. Both management strategies are consistent with national recommendations though the relative effectiveness of each is unknown. The authors have retrospectively compared outcomes of patients admitted electively to WMPU with unplanned admissions at another hospital in the same city, University Hospitals Birmingham NHS Foundation Trust (UHB). Twenty consecutive admissions at each site were included in the study and followed up for at least one year. The total number of readmissions (13 vs. 47), the average number of readmissions per patient (0.7 ± 0.2 vs. 2.4 ± 1.7; p = .002) and the percentage of patients readmitted (40% vs. 100%) were significantly lower at WMPU compared with UHB. This study suggests that patients managed with an elective approach to alcohol detoxification, following work-up with a dedicated alcohol team in outpatient clinics, are readmitted to hospital with alcohol intoxication or withdrawal significantly less often when compared with patients managed following an unplanned admission.