Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Alcohol withdrawal syndrome (AWS) is a frequent cause of emergency department (ED) visits, and some patients return soon after discharge. Identifying factors associated with short-term ED return may inform targeted interventions. Our primary objective was to identify factors associated with 72-hour ED return and 30-day hospital admission among patients discharged after treatment for AWS.

Methods: We conducted a retrospective review of 318 ED encounters for AWS at a single academic medical center from January 1, 2020, to December 31, 2023. Demographic, psychiatric, housing, insurance, and discharge pharmacology variables were collected. We evaluated ED pharmacologic treatment strategy and discharge taper prescriptions. The primary outcome measure was 72-hour ED return, and the secondary outcome measure was hospital admission within 30 days. We compared groups using chi-square, Shapiro-Wilk, Fisher exact, and Mann–Whitney U tests. Variables with significant univariate associations were included in multivariable logistic regression, and results were reported as odds ratios (OR) with 95% confidence intervals. 

Results: Fourteen patients (4.4%) returned within 72 hours, and 32 patients (10.1%) were admitted within 30 days. On multivariable logistic regression, schizophrenia (OR, 8.59; 95% CI, 2.07-35.61), Medicaid insurance (OR, 4.43; 95% CI, 1.39-14.14), and anxiety (OR, 3.53; 95% CI, 1.10-11.39) were independently associated with increased 72-hour ED return. Homelessness was independently associated with higher 30-day admission (OR, 3.19; 95% CI, 1.26-8.07). Discharge tapers were not associated with either outcome.

Conclusion: Among patients discharged after ED treatment for alcohol withdrawal syndrome, Medicaid insurance, anxiety, schizophrenia, and homelessness were associated with short-term return or admission. These findings suggest that social and psychiatric vulnerability may contribute to short-term ED reuse following discharge after AWS treatment. These results highlight opportunities to strengthen follow-up pathways and to address social determinants of health. Larger, multicenter studies are needed to clarify whether these associations are specific to AWS or reflect broader patterns of ED utilization.