Impact of traumatic brain injury on clinical institute withdrawal assessment use in trauma patients: A descriptive study

Model System:

TBI

Reference Type:

Journal article

Accession No.:

J86114

Journal:

PM & R

Year, Volume, Issue, Page(s):

2021 , 13, 2, 159-165

Publication Website:

Abstract:

Study examined the management of alcohol withdrawal syndrome (AWS) using Clinical Institute Withdrawal Assessment (CIWA) protocol in patients with traumatic brain injury (TBI). A major purpose of CIWA is to guide the addition and titration of central nervous system depressants, most commonly benzodiazepines. Data were collected from 375 patients with head trauma or AWS classification, identified through the trauma center’s trauma registry, who were placed on the CIWA protocol and related medication use. Frequency of elevated CIWA score, length of CIWA administration, and medication administration incidence were abstracted from patients’ medical records. The patients were placed into four categories of TBI severity: No TBI, Mild TBI, Moderate TBI, and Severe TBI). Analyses revealed that the percentage of elevated CIWA scores increased significantly with TBI severity, from 4.5 percent in the No TBI group, up to 12.5 percent in the Mild TBI group, 27.1 percent in the Moderate TBI group, and 50.0 percent in the Severe TBI group. Nominally, lorazepam use showed a similar pattern of escalation with TBI severity, but it did not reach statistical significance. Haloperidol use did significantly escalate with higher TBI severity. No group differences were observed for total lorazepam equivalents or length on the CIWA protocol. The results indicated that TBI diagnosis and higher TBI severity level correlate with higher CIWA scores, but neither increased nor decreased benzodiazepine usage was observed. Antipsychotic use did escalate with TBI diagnosis and severity. The risks versus benefits of minimizing benzodiazepines in patients with TBI who are at risk for AWS warrant future study.

Author(s):