Palmstierna developed a model for predicting delirium during alchol withdrawal. The author is from Karolinska Institute in Stockholm.
Patient selection: alcohol withdrawal
Outcome: delirium
Parameters from stepwise multiple regression:
(1) current infectious disease (pneumonia, urinary tract infection, etc)
(2) heart rate in beats per minute on admission
(3) signs of autonomic nervous system overactivity (sweating, tremor, nausea, tachycardia) AND alcohol concentration > 1 g/L (100 mg/dL, 0.1%) in body fluid
(4) history of epileptic seizure
(5) history of delirium
Parameter |
Finding |
Points |
current infection |
no |
0 |
|
yes |
0.334 |
heart rate |
<= 120 |
0 |
|
> 120 (tachycardia) |
0.126 |
autonomic nervous system overactivity with elevated alcohol concentration |
no |
0 |
|
yes |
0.129 |
history of seizure |
no |
0 |
|
yes |
0.068 |
history of delirious episode |
no |
0 |
|
yes |
0.060 |
where:
• The points are based on the regression coefficients.
• The constant was -0.025.
risk of delirium =
= SUM(points for all 5 parameters)
If none of the findings are present then the risk of delirium is very low if adequately treated.
Purpose: To identify a patient at risk for delirium during alcohol withdrawal using the model of Palmstierna.
Specialty: Toxicology, Emergency Medicine, Critical Care
Objective: risk factors, severity, prognosis, stage
ICD-10: F10.4,