(347) Time From Treatment Initiation to Hospital Discharge in Patients With Alcohol Withdrawal Syndrome

Introduction: Alcohol withdrawal syndrome (AWS) is a common, highly comorbid condition in hospitalized patients, which complicates and prolongs hospital care. AWS manifests itself in various symptoms, such as nausea, vomiting, tremor, anxiety, hallucinations, seizures, or delirium. This study compared time from initiation of treatment for AWS to hospital discharge in patients who received benzodiazepines or phenobarbital in three diverse hospitals.

Methods: This was a retrospective chart review of unique, hospitalized patients (N = 75), admitted and treated for AWS between April 1, 2021, and August 31, 2021. Chart abstractors were experienced inpatient pharmacists and physicians who underwent standardized training. AWS treatment was categorized as mainly benzodiazepine or mainly phenobarbital based on a combination of documented clinical intent, medications received, and therapeutic effects. The outcome of interest was time from medication administration to hospital discharge, hypothesizing that patients who received phenobarbital would result in faster resolution of AWS and thus shorter time to hospital discharge than patients who received benzodiazepines.

Results: Among patients hospitalized and treated for AWS, 49% received mainly benzodiazepines and 51% received mainly phenobarbital treatment. Most patients had a history of alcohol use two years prior to or at the time of hospitalization, and patients previously hospitalized for AWS requiring treatment were more common in the phenobarbital group. Majority of patients (92%) had a timely diagnosis of AWS. The median time from AWS treatment initiation to discharge was 5.5 [IQR 6.00] and 3.83 [IQR 5.61] days in the mainly benzodiazepines and mainly phenobarbital groups, respectively [p-value = 0.849].

Conclusions: In patients who received a timely diagnosis of AWS and were treated with mainly benzodiazepines or mainly phenobarbital, there were no significant difference in the time from initiation of treatment to hospital discharge. The sample size of the study was small to assess for differences between the groups. Additionally, the decision on main treatment strategy was made subjectively by the chart abstractor, and data were limited to what were available on Epic and any other external hospital records accessible through Epic.