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Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement.
American Journal of Respiratory and Critical Care Medicine ( IF 19.3 ) Pub Date : 2021-10-01 , DOI: 10.1164/rccm.202108-1845st
Tessa L. Steel , Majid Afshar , Scott Edwards , Sarah E. Jolley , Christine Timko , Brendan J. Clark , Ivor S. Douglas , Amy L. Dzierba , Hayley B. Gershengorn , Nicholas W. Gilpin , Dwayne W. Godwin , Catherine L. Hough , José R. Maldonado , Anuj B. Mehta , Lewis S. Nelson , Mayur B. Patel , Darius A. Rastegar , Joanna L. Stollings , Boris Tabakoff , Judith A. Tate , Adrian Wong , Ellen L. Burnham

Background: Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. Goals: This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T0-T4 continuum to advance the care of hospitalized patients who experience SAWS. Methods: Clinicians and researchers with unique and complementary expertise in basic, clinical, and implementation research related to unhealthy alcohol consumption and alcohol withdrawal were invited to participate in a workshop at the American Thoracic Society 2019 International Conference. The committee was subdivided into four groups on the basis of interest and expertise: T0-T1 (basic science research with translation to humans), T2 (research translating to patients), T3 (research translating to clinical practice), and T4 (research translating to communities). A medical librarian conducted a pragmatic literature search to facilitate this work, and committee members reviewed and supplemented the resulting evidence, identifying key knowledge gaps. Results: The committee identified several investigative opportunities to advance the care of patients with SAWS in each domain of the translational science spectrum. Major themes included 1) the need to investigate non-γ-aminobutyric acid pathways for alcohol withdrawal syndrome treatment; 2) harnessing retrospective and electronic health record data to identify risk factors and create objective severity scoring systems, particularly for acutely ill patients with SAWS; 3) the need for more robust comparative-effectiveness data to identify optimal SAWS treatment strategies; and 4) recommendations to accelerate implementation of effective treatments into practice. Conclusions: The dearth of evidence supporting management decisions for hospitalized patients with SAWS, many of whom require critical care, represents both a call to action and an opportunity for the American Thoracic Society and larger scientific communities to improve care for a vulnerable patient population. This report highlights basic, clinical, and implementation research that diverse experts agree will have the greatest impact on improving care for hospitalized patients with SAWS.

中文翻译:

严重戒酒综合症住院治疗的研究需求:美国胸科学会官方研究声明。

背景:严重酒精戒断综合征(SAWS)在住院患者中发病率高、费用高且常见,但指导住院患者管理的证据却很少。该领域的研究需求广泛,涵盖转化科学领域。目标:本研究声明旨在描述对 SAWS 的了解,确定知识差距,并为医学研究所 T0-T4 连续体的每个领域的研究提供建议,以促进经历 SAWS 的住院患者的护理。方法:邀请在不健康饮酒和戒酒相关的基础、临床和实施研究方面具有独特和互补专业知识的临床医生和研究人员参加美国胸科学会2019年国际会议的研讨会。该委员会根据兴趣和专业知识分为四个组:T0-T1(基础科学研究转化为人类)、T2(研究转化为患者)、T3(研究转化为临床实践)和T4(研究转化为人类)到社区)。一名医学图书馆员进行了务实的文献检索以促进这项工作,委员会成员审查并补充了所得证据,确定了关键的知识差距。结果:委员会确定了几个研究机会,以在转化科学领域的每个领域推进 SAWS 患者的护理。主要主题包括1)研究用于酒精戒断综合征治疗的非γ-氨基丁酸途径的必要性;2) 利用回顾性电子健康记录数据来识别风险因素并创建客观的严重程度评分系统,特别是对于患有 SAWS 的重症患者;3) 需要更可靠的比较有效性数据来确定最佳的 SAWS 治疗策略;4) 加速将有效治疗方法付诸实践的建议。结论:缺乏证据支持 SAWS 住院患者(其中许多人需要重症监护)的管理决策,这既是美国胸科学会和更大的科学界改善弱势患者群体护理的呼吁,也是一个机会。本报告重点介绍了基础、临床和实施研究,众多专家一致认为这些研究将对改善 SAWS 住院患者的护理产生最大影响。
更新日期:2021-10-01
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