(944) Evaluation of Phenobarbital for Alcohol Withdrawal in an Emergency Department

Introduction: The objective of this study was to evaluate clinical outcomes associated with phenobarbital in alcohol withdrawal and describe practice patterns of phenobarbital in the emergency department (ED). Benzodiazepines are first-line treatment options for alcohol withdrawal but are associated with poor clinical outcomes such as increased hospital and intensive care unit (ICU) length of stay. Phenobarbital is an emerging treatment option that may provide additional advantages.

Methods: This was a retrospective chart review at a large academic medical center. Patients being treated for alcohol withdrawal in the ED who received phenobarbital in addition to a symptom-triggered lorazepam-based protocol were compared to patients who only received a symptom-triggered lorazepam-based protocol. The primary outcome evaluated was the patient’s final disposition. Secondary outcomes included ICU and hospital length of stay, need for additional phenobarbital doses, reduction in Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA) scores, incidence of adverse events, and mechanical ventilation. Descriptive statistics were utilized to analyze outcomes as well as baseline characteristics.

Results: Both control and intervention arms had 25 patients each. Two patients (8%) were discharged from the ED in both the control and intervention arm. There were 19 (76%) patients admitted to a general medicine floor in the control arm and 23 (92%) patients admitted to a general medicine floor in the intervention arm. A total of 4 (16%) patients were admitted to an ICU in the control arm and no patients were admitted to an ICU in the intervention arm. Median total dose of benzodiazepines in lorazepam equivalents was 15 mg in the control arm vs 8 mg in the intervention arm. Median reduction in CIWA score was 4 points in the control arm and 8 points in the intervention arm. There was no difference in hospital length of stay and no difference in incidence of mechanical ventilation and seizures in either group.

Conclusions: Phenobarbital use in alcohol withdrawal resulted in an overall trend in decreased ICU length of stay, decreased benzodiazepine use, and greater reduction in CIWA scores. Further study is needed to evaluate the impact on meaningful clinical outcomes.