Original Research
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Benzodiazepines (BZD) are considered standard of care for management in alcohol withdrawal syndrome (AWS); however, phenobarbital (PHB) has been shown to be safe and effective in the treatment of AWS, as well as reducing admissions to the intensive care unit (ICU).
Research Question or Hypothesis: The purpose of this study is to evaluate whether administration of PHB in the ED without continuation upon admission reduces overall hospital length of stay in AWS.
Study Design: Single-center, retrospective chart review from 2019 to 2021.
Methods: 200 patients at least 18 years old were included if they had a primary diagnosis of AWS and received either a dose of lorazepam or intravenous phenobarbital from the facility AWS order set. Patients were excluded if they were pregnant or discharged against medical advice. The first one hundred patients in each group that met inclusion criteria were included for analysis. The primary outcome assess was hospital length of stay with secondary outcomes assessing ICU length of stay, median CIWA scores, total BZD usage, and discharge disposition.
Results: There was a significant decrease in the length of stay of the 94 patients who received a PHB bolus compared to the 106 patients who did not get a bolus (one day versus 5 days; p<0.01). Median CIWA scores were lower for both day 1 (5.4 to 7 days; p=0.04) and day 2 (4.8 to 6.6; 9=0.04) in the PHB group. Hospital admissions were significantly less in the PHB group at 42% vs 74% requiring admission (p<0.01). When evaluating only LOS for admitted patients, the PHB group remained significantly less (5 days vs 6 days, p=0.04). There were no differences in the amount of safety events between the two groups.
Conclusion: A single bolus dose of phenobarbital in the ED was associated with decreased hospital LOS, hospital admissions, and early CIWA scores with no differences is safety endpoints.
Presenting Author
Joel Huffman Pharm.D., BCCCPWesley Medical Center
Authors
Brian Gilbert Pharm.D., MBA, BCPS, BCCCP, FCCM
Wesley Medical Center
Charles Wilson Jr. Pharm.D., BCCCP
Wesley Medical Center