Unnecessary Use of Medications for Alcohol Withdrawal Among Hospitalized Patients: A Retrospective Study of...

Alcohol withdrawal is frequently encountered in hospital settings, but the decision to treat the withdrawal with pharmacotherapy is often made without knowing if treatment is even necessary. Testing for phosphatidylethanol (PEth), results of which correlate well with recent alcohol consumption, may allow hospital teams to avoid treating alcohol withdrawal unnecessarily. To investigate PEth values of those suspected of alcohol withdrawal syndrome (AWS) among hospital inpatients, we conducted a retrospective study to determine the prevalence of hospitalized patients who received pharmacotherapy for withdrawal who also demonstrated PEth values suggesting minimal recent drinking.

This retrospective study examined the electronic health records of hospitalized adult patients suspected of recent heavy alcohol use for whom PEth tests were ordered. PEth tests were ordered at the time to inform treatment decisions such as the provision of naltrexone or referral to ongoing psychosocial treatments, but not to inform the decision to treat AWS given that results would only be available 3 or more days later. Hospital inpatients, excluding emergency room encounters, for whom PEth was ordered at 2 affiliated academic hospitals from January 2021 to April 2024 were included.

The included cohort was composed of 73 individual encounters. Among the 45 (62%) encounters where pharmacotherapy for AWS was administered, 14 (31%) had PEth values (≤200 ng/ml) inconsistent with heavy alcohol use.

Results suggest that a substantial proportion of hospital inpatients may have received pharmacotherapy for AWS despite PEth levels inconsistent with recent heavy alcohol use. If PEth results are available in real-time, results could help clinicians decide if pharmacotherapy is warranted. Further study of PEth testing and its role in the care of hospitalized patients is recommended.