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Published on: November 9, 2016
Evaluation of the Brief Alcohol Withdrawal Scale Protocol at an Academic Medical Center
Brian K Lindner1, Vi T Gilmore, Rachel M Kruer
1Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD (BKL, VTG, RMK, ASJ); Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (AAHA, TN); Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (ESC); Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD (PM, KP); Center for Chemical Dependence, Johns Hopkins Bayview Medical Center, Baltimore, MD (DAR); Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD (SY).
Objectives:
The standard of care for treatment of alcohol withdrawal is symptom-triggered dosing of benzodiazepines using a withdrawal scale. Abbreviated scales are desired for clinician efficiency. The objective of this study was to evaluate the use of the 5-item Brief Alcohol Withdrawal Scale (BAWS) protocol.
Methods:
This single-center, retrospective, observational, cohort study assessed patients ordered the BAWS protocol between August 1, 2016 and July 31, 2017. Data were collected on benzodiazepine exposure, duration of treatment, withdrawal severity, agitation, over-sedation, and delirium while being treated for alcohol withdrawal. Comparisons were made to analyze predetermined patient subgroups.
Results:
Seven hundred ninety-nine patients were initiated on the BAWS protocol. Patients received a median (IQR) of 0 (0-4) lorazepam equivalents (LEs) and were on the BAWS protocol for a median (IQR) of 44.9 (22.4-77.2) hours. Of the patients that received benzodiazepines while on the BAWS protocol, a median (IQR) of 4 (2-11) LEs were given. Seventeen (2.1%) patients had severe withdrawal. Days of agitation, over-sedation, and delirium were minimal, with the median (IQR) of 0 (0-0). Few patients received adjunctive medications for symptom management. Intensive care unit (ICU) patients had more severe withdrawal than non-ICU patients, but received the same cumulative benzodiazepine dose.
Conclusions:
Most patients on the BAWS protocol received little-to-no benzodiazepines; severe withdrawal, agitation, delirium, or over-sedation were uncommon. This is the first evaluation of the BAWS protocol on a diverse population of hospitalized patients.
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