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Pharmacological Interventions for Alcohol Withdrawal Syndrome Among Hospitalized Adults: A Multicenter Cohort Study
Brody A Erfle1, Tessa L Steel2, Anica C Law3
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Background:
Alcohol Withdrawal Syndrome occurs in 1 in 43 hospitalized patients and is associated with increased morbidity. Pharmacotherapy for patients hospitalized with alcohol withdrawal syndrome are incompletely described. Understanding current practice patterns is essential to improving outcomes and addressing variability in care.
Objective:
To identify alcohol withdrawal syndrome treatment practice patterns across United States hospitals.
Design:
Multicenter retrospective cohort study with data collected between quarter 1 of 2016 and quarter 3 of 2022 using Premier Incorporated Artificial Intelligence Healthcare Database (~ 25% of United States hospital admissions; excludes emergency room care).
Participants:
A total of 245,271 adult inpatients with a primary diagnosis of alcohol withdrawal syndrome.
Main Measures:
The outcomes were alcohol withdrawal syndrome medication treatment patterns, including initial treatment regimens, dosage trends, and factors associated with medication choice.
Key Results:
Among 245,271 patients with alcohol withdrawal syndrome, 226,816 [92.5%] received benzodiazepines, 28,123 (11.5%) phenobarbital, and 113,746 (46.4%) other AWS agents within the first five days of admission. The most common initial treatment regimens were benzodiazepines alone (56.0%), benzodiazepines and other agents together (22.2%), and benzodiazepines and phenobarbital together (3.8%). Median daily benzodiazepine dose (diazepam equivalents) peaked on hospital day 2 (46.2 [interquartile range 23.1-84.2] mg), whereas median daily phenobarbital dose peaked on hospital day 1 (260 [120-520] mg). Type of medication used was associated with level of care at admission, hospital facility, and United States geographical region. In adjusted analyses, the admission hospital was associated with phenobarbital use (median odds ratio 4.21 [95% confidence interval 4.03-4.40]), benzodiazepine use (median odds ratio 3.09 [2.96-3.23]) and other agents (median odds ratio 1.65 [1.62-1.67]).
Conclusions:
Alcohol withdrawal syndrome treatment varied by level of care at admission and hospital, highlighting significant variability in practice patterns. These findings inform future trials comparing the effectiveness of different medication regimens.
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