Comparative outcome in patients with delirium tremens receiving care in emergency services only versus those receiving comprehensive inpatient care

BACKGROUND: Delirium tremens (DT) is a medical emergency. Many cases are treated and discharged from emergency services (ES), after complete or partial resolution of delirium. Few receive comprehensive inpatient addiction treatment (CIAT) after the initial emergency management. OBJECTIVE: The objective of this study was to compare 6-month outcomes of treatment in alcohol-dependence syndrome (ADS) patients presenting with DT receiving either only emergency care or emergency care along with CIAT. MATERIALS AND METHODS: In this prospective observational study, all patients of ADS presenting in DT over a 1-year period were followed up for 6 months. Patients who received care only in the emergency services (ES) (111) were compared with patients who received ES followed by CIAT (90). Primary followup measure was regular followup (RFU) at outpatient department, and patients not presenting for RFU received telephonic followup (TFU). Alcohol use status was monitored at 6 months, as per Feuerlein and Küfner criteria. RESULTS: Patients who received both ES and CIAT had better RFU compared to patients treated in the ES alone at 6 months (71/90 vs. 17/111, respectively, P < 0.005). CIAT also resulted in better combined follow-up (RFU and TFU) (85/90 vs. 60/111, respectively, P < 0.005). Compared to ES treatment group alone, ES plus CIAT group had fewer relapses (41/85 vs. 42/60, respectively, P < 0.05). The most common reason for direct discharge from ES was nonavailability of beds for inpatient treatment. CONCLUSIONS: Merely emergency treatment of ADS patients presenting with DT does not provide satisfactory treatment outcome with respect to alcohol use. ES treatment followed by CIAT ensures better outcome in the form of fewer relapses and better follow up.