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A Novel Scoring System to Guide Risk Assessment of W ernicke's Encephalopathy
Author(s) -
Green Amy,
Parker Richard,
Williams Tim M.
Publication year - 2013
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.12028
Subject(s) - thiamine , medicine , scoring system , encephalopathy , intensive care medicine , wernicke encephalopathy , thiamine deficiency , risk assessment , population , pediatrics , environmental health , computer security , computer science
Background Thiamine deficiency in patients who abuse alcohol can cause W ernicke's encephalopathy ( WE ). Thiamine supplements are given to prevent this complication. Guidelines exist for giving thiamine supplementation in the inpatient population. However, similar guidelines are not available for clinicians detoxifying patients in the community, and consequently, assessment of risk of WE and prophylaxis can be inconsistent. Methods A scoring system to assess risk of WE was developed and evaluated by comparing practice before and after introduction of the system. One hundred and twenty‐six cases requiring alcohol detoxification were examined: 94 before introduction of the scoring system and 32 afterward. Results Before introduction of the scoring system, a risk assessment for developing WE was performed in 30% of patients and parenteral thiamine prescribed in 32%. After introduction of the scoring system, risk assessment and administration of parenteral thiamine increased to 100 and 75%, respectively. There was 1 probable case of WE before introduction of the scoring system and none afterward. Conclusions We conclude that assessment of WE is often inadequate, leading to inadequate thiamine administration. The new scoring system allows simple, structured risk assessment for WE and thus guides appropriate thiamine administration. This is of most value to clinicians treating the consequences of alcohol dependence in the community.