Hospitalists and alcohol withdrawal: Yes, give benzodiazepines but is that the whole story?

Finn, Kathleen; Greenwald, Jeff

doi:10.1002/jhm.966

Cited by 2 publications

(3 citation statements)

References 31 publications

(32 reference statements)

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“…It has also been reported that hospitalized patients without alcohol use disorder may be placed on symptom-triggered protocols inappropriately [10] and that adding a symptom-triggered component based on CIWA scores to protocols at one hospital was associated with increased mortality and length of stay [11]. The literature supporting symptomtriggered therapy has also been questioned for being unrepresentative of general medical inpatients [12]. Given this uncertainty, we undertook a systematic review of all randomized controlled studies comparing symptom-triggered therapy to fixed dose schedules to assess whether symptom-triggered therapy was associated with improved mortality, delirium, seizure, duration of therapy, and total dose of benzodiazepine.…”

Section: Introductionmentioning

confidence: 99%

Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials

2019

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Section: Introductionmentioning

confidence: 99%

Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials

2019

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“…1,2 Despite its prevalence, relatively little has been published describing patients hospitalized on acute care wards with alcohol withdrawal. 3,4 Many published series on alcohol withdrawal are either relatively small or come from specialized alcohol withdrawal centers that are poorly generalizable to the acute care wards. 5 In 2020 The American Society of Addiction Medicine (ASAM) published the first detailed clinical practice guideline for the management of alcohol withdrawal, including for patients hospitalized on acute care wards.…”

mentioning

confidence: 99%

“…Alcohol withdrawal is a common reason for admission to acute care hospitals 1,2 . Despite its prevalence, relatively little has been published describing patients hospitalized on acute care wards with alcohol withdrawal 3,4 . Many published series on alcohol withdrawal are either relatively small or come from specialized alcohol withdrawal centers that are poorly generalizable to the acute care wards 5 …”

mentioning

confidence: 99%

Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study

Ronan,

Gordon,

Skanderson

et al. 2024

J Addict Med

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Objectives Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM). Methods We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse. Inpatient management and hospital outcomes were obtained by chart review. Factors associated with treatment duration and complicated withdrawal were examined. Results Of the 594 patients included in this study, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone. The most common medication given was lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%), and phenobarbital (6%). Symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57–0.80) and front loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62–0.92) were associated with reduced treatment duration. Lorazepam (RR, 1.20; 95% CI, 1.02–1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06–1.54) were associated with increased treatment duration. Lorazepam (adjusted odds ratio, 4.30; 95% CI, 1.05–17.63) and phenobarbital (adjusted odds ratio, 6.51; 95% CI, 2.08–20.40) were also associated with complicated withdrawal. Conclusions Overall, our results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. Health care systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations.

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Hospitalists and alcohol withdrawal: Yes, give benzodiazepines but is that the whole story?

Cited by 2 publications

References 31 publications

Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study

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