A Novel Scoring System to Guide Risk Assessment of Wernicke's Encephalopathy
Reprint requests and Present address: Amy Green, MA, OXON, MBChB, MRCPsych, Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Based Medicine, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK. Tel.: +44(0)117 331 4007; Fax: +44(0)117 331 4026; E-mail: email@example.com
Thiamine deficiency in patients who abuse alcohol can cause Wernicke'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.
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.
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.
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.