Medical Management of Acute Alcohol Withdrawal in Hospitalized Patients at a Community Based Network of Hospitals: A Retrospective Cohort Study

Anna Squibb¹*, Kathleen Patton², Claire Nelson³ and Bhakti Chauvin⁴

Published: June 28, 2022

DOI: 10.55162/MCMS.03.049

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Abstract  

Background: In the United States over 500,000 episodes of alcohol withdrawal require pharmacological treatment each year [1]. The medications for withdrawal treatment in the U.S. are benzodiazepines and barbiturates. Studies suggest these treatments are equivocal, [2] however, studies comparing outcomes of the two medications have been limited.
Objective: The primary objective of this study is to compare alcohol withdrawal treatment with benzodiazepine and phenobarbital medication classes alone or in combination in hospitalized patients in a 8 hospital community-based healthcare system.
Methods: This is a retrospective review of 1,602 hospital encounters with a principal diagnosis of alcohol withdrawal from 01/01/2018 to 12/31/2019. Encounters were evaluated for type of pharmacologic treatment, 30-day readmission rate, ICU admission, and intubation rates.
Results: When comparing the treatment groups, patients in the phenobarbital treatment group compared to the benzodiazepine group had a statistically significant higher admission to ICU at 42% versus 28% respectively (p=0.0160). Phenobarbital and benzodiazepines were not statistically significantly different in intubation rate (p= 0.3690) or 30-day readmission rate (p=0.8626). Rates of 30-day readmission and intensive care (ICU) admission were statistically significant between the three pharmacologic treatment groups (p<0.001) with the combination of phenobarbital and benzodiazepines demonstrating the highest rates of both.
Conclusion: In other similar studies [8-11], there are varied outcomes in relation to ICU admission, intubation and 30-day readmission rates when comparing benzodiazepines and phenobarbital. This study further demonstrates variation in these outcomes. Due to these substantial differences in outcomes when comparing phenobarbital and benzodiazepines, higher level studies are needed to provide conclusive evidence that phenobarbital is equivocal or superior to use of benzodiazepines for the treatment of alcohol withdrawal.

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