Predictors of Emergency Department Return Among Patients Discharged After Treatment for Alcohol Withdrawal Syndrome

Alcohol withdrawal syndrome (AWS) is a frequent cause of emergency department (ED) visits, and some patients return soon after discharge. Identifying clinical and social risk factors for ED short-term recidivism may inform targeted interventions and improve post-ED outcomes.

We conducted a retrospective review of 318 ED encounters for AWS at a single academic medical center from January 1, 2020, and December 31, 2023. Demographic, psychiatric, housing, insurance, and discharge pharmacology variables were collected. The primary outcomes were 72-hour ED return and 30-day hospital admission. Group comparisons were performed using chi-square, Shapiro-Wilk, Fisher’s exact, and Mann–Whitney U tests. Variables with significant univariate associations were entered into multivariable logistic regression, with results reported as odds ratios (ORs) with 95% confidence intervals (CIs).

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) . Depression was not independently associated with 30-day admission. Discharge tapers and ED treatment strategy were not associated with either 72-hour return or 30-day admission.

Among patients discharged after ED treatment for AWS, Medicaid insurance, anxiety, schizophrenia, and homelessness were independently associated with short-term return or admission. These findings suggest that social and psychiatric factors may play a greater role in post-discharge outcomes than pharmacologic regimen, highlighting opportunities to strengthen follow-up pathways and address social determinants of health. Larger, multicenter studies with adequately powered multivariable models are warranted to validate these associations.