这位住院的病人会患上严重的戒酒综合症吗? : 理性的临床检查系统审查
Evan Wood1,2, Loai Albarqouni3, Stacey Tkachuk2
1British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
JAMA
|September 1, 2018
概括
预测严重的酒精戒断综合征 (SAWS) 由于其高死亡率至关重要. 组合评估工具,如PAWSS,有效地识别有风险的患者,改善早期戒酒干预策略.
科学领域:
- 临床医学
- 药理学
- 公共卫生
背景情况:
- 严重的戒酒综合征 (SAWS) 具有显著的发病率和死亡率风险.
- 早期识别高风险SAWS患者对于及时干预至关重要.
- 大多数有风险的患者不会发展SAWS,因此需要准确的预测措施.
研究的目的:
- 评估各种症状和迹象的准确性和预测价值,以识别患有SAWS风险的住院患者.
- 评估风险评估工具在预测严重酒精戒断方面的有用性.
- 将SAWS定义为惊发作,戒断发作或临床诊断的严重戒断.
主要方法:
- 对MEDLINE和EMBASE数据库 (1946年至2018年1月) 进行了系统的文献搜索.
- 包括的研究比较了SAWS患者和无SAWS患者的症状,症状和风险评估工具.
- 使用元分析来计算预测因素的概率比率 (LR),灵敏度和特异性.
主要成果:
- 分析了14项高质量的研究,涉及71,295名患者.
- 在病史中出现过神经 (LR,2. 9) 和血压基线≥140 mm Hg (LR,1. 7) 增加了SAWS的可能性.
- 预测酒精戒断严重程度尺度 (PAWSS) 显示出高效率 (≥4个发现的LR174;≤3个发现的LR0.07).
结论:
- 结合评估工具有效地识别出患有SAWS风险的患者.
- 在急性护理环境中,PAWSS工具对风险分层有显著的前景.
- 需要进一步验证这些工具以提高可通用性.
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