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Publication Date

2024

Keywords

oregon, ppmc, oregon gme

Disciplines

Emergency Medicine | Medical Education | Pharmacy and Pharmaceutical Sciences | Substance Abuse and Addiction

Abstract

Abstract: According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in the US, alcohol use contributes to up to five million emergency department (ED) visits annually. Alcohol withdrawal syndrome (AWS) is a serious and potentially life-threatening condition that can lead to complications such as hallucinations, seizures, and delirium tremens. For many years, the standard treatment for AWS has been symptom-triggered benzodiazepines, often dosed based on symptom scoring tools such as the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) Score. In recent years, the use of phenobarbital for AWS management has gained popularity, and studies investigating its safety and efficacy seem promising. These studies have primarily compared phenobarbital to benzo-based strategies and suggest improved clinical outcomes with phenobarbital, such as reduced ICU admissions, reduced 30-day ED readmission, and reduced respiratory complications. However, this data is spread across various dosing strategies and populations over time, harming its external validity. The purpose of this study is to compare outcomes with current dosing strategies of lorazepam and phenobarbital in the management of AWS patients at an urban emergency department. This retrospective cohort review analyzes ED patients from September 2019 to August 2023 who were treated for AWS with either lorazepam or phenobarbital. Data has been collected for 211 lorazepam patients and 245 phenobarbital patients. Only those > 18 years old are included. The only exclusion is known hypersensitivity to either medication. The primary outcome is differences in hospital admission, with key secondary outcomes including respiratory complications, ICU admissions, and ED readmission within 7 days. Initial data collection is complete, and analysis is currently underway (IRB approved). Results will be shared as they become available. Learning objectives: Compare the safety and efficacy of lorazepam and phenobarbital for the treatment of AWS in the emergency department. Presentation Category: Critical care/cardiology/emergency medicine/ nutrition support

Specialty/Research Institute

Graduate Medical Education

Specialty/Research Institute

Emergency Medicine

Specialty/Research Institute

Pharmacy

Retrospective review of phenobarbital versus lorazepam for alcohol withdrawal Syndrome in the Emergency Department

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