Title : No sex difference in clinical characteristics or treatment outcomes of alcohol withdrawal syndrome (AWS) in 148 hospitalized adolescents
Abstract:
Background: Recent studies suggest that alcohol consumption is increasing in adolescent females but little is known about AWS in this population. Adolescent females may have unique, unknown vulnerabilities as prior studies of AWS focus on males.
Objective: To characterize the demographics of AWS in adolescents and assess potential sex differences in AWS in adolescents.
Methods: Electronic medical records of 130 hospitalized adolescent patients (14-20 years old with 148 hospitalizations) who received care at Mayo Health System and were placed on CIWA-Ar protocol for AWS from 6/2019-6/2022 were included in the study.
Results: Males (53.8%, n=70) and females (46.2%, n=60) were equally represented (p=0.51). Both sexes had high rates of depression (females/males, 51.7%/38.6%, p=0.15), anxiety (30%/18.6%, p=0.15), suicide attempts (25%/22.9%, p=0.83), cannabis (26.7%/18.6%, p=0.23) and tobacco use (23.3%/14.3%, p=0.25). Admission blood alcohol concentration was higher for males (Median (IQR)=151(286,5) vs 107(155) mg/dL) with no significant difference (p=0.15). GI disorders were the most common comorbidity for both sexes (16.7%/14.3%, p=0.80). Females had more asthma (10%/0%, p=0.0094) and sexually transmitted diseases (6.7%/0%, p=0.04).
24% of males and 20% of females were admitted to ICU. No significant difference in hospital or ICU LOS despite that females stayed at the hospital longer (p=0.23), and males had longer ICU stay (p=0.63). There was no sex difference in total lorazepam equivalent dose between sexes (p=0.35). Females (20% vs 17.6% males) needed a higher total haldol equivalent dose (p=0.46). The time from admission to maximum AWS symptomatology, determined by peak CIWA-Ar score, was longer for females (p=0.10). 26.1% of females and 25.3% of males had CIWA-Ar score ≥10 with no sex difference (p>0.9). Patients with CIWA-Ar ≥10 (vs those with CIWA-Ar <10) required more benzodiazepine [median (IQR)=5 (16.63)/2(8.87) mg, p=0.035), stayed shorter at the hospital [median (IQR)=67.6 (92.7)/73.8 (82.24) hr,p=0.8], and the ICU [median (IQR)=26.4 (30)/34 (26.54) hr, p=0.9]. ICU patients needed more benzodiazepine [median (IQR)=20 (29.75) mg/2.25 (5.75) mg, p=0.0003] and longer time from admission to peak CIWA-Ar [median (IQR)=21.19 (38.08)/7.9 hours (17.78), p=0.0166] than non-ICU admitted patients. Patients who received benzodiazepine treatment had higher CIWA-Ar scores [median (IQR)=12 (10)/6 (5), p=0.0001] and shorter hospital LOS [median (IQR)=65 (87.25)/75 (85.25) hr, p=0.57].
Conclusion: Adolescent females and males with AWS have similar clinical characteristics, disease courses, and treatment outcomes. Benzodiazepine-treated patients had shorter hospital stays despite higher peak CIWA-Ar scores in both sexes.
Audience Take Away Notes:
- Recognizing the course of AWS, especially in the young female population is becoming more important because of the increasing number of young female alcoholics and closing the sex gap in alcohol abuse.
- Possible sex differences in clinical course and treatment are unknown, as AWS studies mostly included adult males. This study helps understand the possible sex differences in the clinical course and treatment of AWS in adolescents.
- Considering the increasing number of alcoholics among the youth, it can be predicted that the age of AWS will decrease. Therefore, the importance of recognizing and treating AWS in adolescents has increased. There are very few adolescent AWS clinical studies in the literature therefore this study helps to understand demographics, comorbid conditions, course of AWS, and treatment in adolescents.
- As our study revealed, AWS is seen at similar rates and with similar severity in adolescent females and males. Our study will contribute to approach diagnosis and treatment by being aware of this when treating adolescent females.
- This study helps physicians to consider prescribing benzodiazepine to adolescent AWS patients with higher CIWA-Ar scores to decrease hospital length of stay and to be more comfortable with treating female adolescents with AWS.
