MD39S07: Delirium tremens

Bottom line: Information on delirium tremens (alcohol withdrawal) was used to persuade other health professionals to make a change (prescription of benzodiazepine). There were no information-related patient health outcomes.

Acquisition: On November 1, 2008, MD39 did a search at work, with residents, and during an encounter with a patient (hospitalized), in the meeting room. MD39 retrieved one information hit about alcohol withdrawal. The reported search objectives were: to address a clinical question, to fulfill an educational or research objective, and to exchange information with other health professionals. “I was at the hospital. [...] It was during the rounds. [...] The patients are in their rooms and the residents see them. [Then] we discuss the cases one by one. [...] I was challenging the residents a lot: what is proven effective in preventing delirium tremens during hospitalization? [...] [The patient was] a man, around 50 years old. [...] He was agitated. [...] It was a quite a delirium. [...] [The clinical question was about] benzodiazepines, neuroleptics, thiamine. [...] [Do we need] to give benzodiazepines? [For] example, does it prevent delirium tremens when the patient is admitted to the hospital? Or does it make the patient more confused, so it is better to wait until they become delirious before giving it, in other words, wait until they have symptoms. [Was it for residents?] Absolutely. [...] We usually have two.” According to MD39, Essential Evidence+ (EE+) was the only source for information, and the found information was relevant.

Cognition: One hit was associated with a report of a positive cognitive impact (confirmation). “I already had something in mind, yes. I like being right in what I tell the residents.”

Retrieved information hit(s):

1) NGC Practice Guidelines (CIRT): Management of alcohol withdrawal delirium (ASAM)

Application: Information on alcohol withdrawal was retrieved, and was used to persuade another health professional to make a change (information used as presented in EE+). “I remember that we changed the prescription for the patient. He was prescribed neuroleptics by the night staff, and the next day we were trying to choose between benzodiazepines and neuroleptics to calm the agitation of this patient. [...] I think we switched him to benzodiazepines. [...] [Then] the patient [...] felt better after a few days, as it usually happens. [...] I think it allowed the residents to improve a little bit their clinical reasoning. [...] [For me] it is something that I had already figured out from my personal searching in the literature. [...] [The information was used to persuade] another health professional. [I consider] the residents as other professionals.”

Outcomes: Without this information hit, MD39’s management of the patient would have been the same. There is no clear relationship between the information use and expected health outcomes.

Type of path: No outcome

Acquisition	Cognition	Application	Outcomes
Address a clinical question Fulfill educational objective Exchange information	Confirmed	Persuade Be more certain	No outcome