Sex differences in the 1-year outcomes of emergency department patients with alcohol withdrawal

Alcohol withdrawal is a common emergency department (ED) presentation, but differences in long-term outcomes between female and male patients are not clear.

From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, British Columbia, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics and ED treatments. We linked with regional ED and provincial data to obtain the outcomes of 1-year return ED visits and mortality, respectively. The primary outcome was at least one return visit to the ED, and secondary outcomes included ED revisits and 1-week, 1-month, and 1-year mortality. We compared female patients with male patients using descriptive methods.

We identified 1,019 unique patients with 273 (26.8%) female. Median ages, ambulance arrival, initial withdrawal severity score, and index visit admission rates were similar. At 1 year, 186 (68.1%) female and 515 (69.0%) male patients reattended an ED, for a difference of 0.9%; (95% CI - 5.5 to 7.7%). A significantly greater proportion of male patients reattended at 1 week and 1 month, and the average number of male ED revisits was greater at 1 week, 1 month, and 1 year. By 1 year, a female patient (0.4%) and 19 males (2.6%) died, for a difference of 2.2% (95% CI 0.3-3.6%).

Despite similar ED presentations, female patients with alcohol withdrawal had fewer 1-year ED visits and lower mortality. EDs may wish to incorporate sex-specific approaches to post-discharge management.