362 Mismatch of empiric treatment and thiamine deficiency in emergency department patients without alcohol dependence

Document Type

Conference Proceeding

Publication Date

5-13-2024

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: Thiamine (vitamin B1) deficiency is recognized as a treatment consideration in critical illnesses. Clinicians often consider treatment in the emergency department (ED) when patients have alcohol use disorder, but the identification and treatment of patients without alcohol use disorder in the ED is not well studied. Our objective was to determine the association between thiamine treatment and thiamine deficiency in ED patients without a history of alcohol use disorder. Methods: This was a secondary analysis of an observational study assessing thiamine deficiency in adult ED patients. We excluded patients with known alcohol use disorder. Investigators collected whole blood levels on all patients in ED, which measure thiamine-diphosphate. We collected demographic and clinical characteristics that could contribute to nutritional deficiencies. Analysis consisted of descriptive statistics and logistic regression to assess the relationship between thiamine treatment, defined as intravenous administration of thiamine, and deficiency, defined as a whole blood level below the normal reference range. Analysis included adjustments for sex and age. Where applicable, we report odds ratios (OR) with 95% confidence intervals (CI). Results: The study included 343 patients, the average age being 57.0 (SD 17.4)?years, 47.5% were female, and 80.5% were Black. Comorbid conditions were significant (50.7% diabetes mellitus, 22.7% chronic kidney disease, 30.3% cancer), and inpatient mortality occurred in 7.3% patients. Thiamine deficiency occurred in 18.4% patients. Thiamine treatment occurred in 7.0% patients. Matched treatment to thiamine deficiency was present in 4.8%. Among those identified with sepsis 9.1% of those with deficiency were treated and 11.7% of those without deficiency were treated. A mismatch between treatment and normal thiamine occurred in 7.5%. There was no significant unadjusted (OR 0.62, 95% CI 0.18–2.14) or adjusted (OR 0.68, 95% CI 0.19–2.38) association with the decision to treat and the presence of thiamine deficiency. Conclusion: In this study, thiamine deficiency was common in a cohort of ED patients with significant disease burden and no history of alcohol use disorder. Clinicians rarely considered thiamine treatment and were poor at identifying those that were deficient. Further research is needed to improve identification of ED patients likely to benefit from treatment.

Volume

31

Issue

S1

First Page

173

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