Symptom-monitored loading: An evaluation of prophylactic medications in patients with severe alcohol withdrawal

The purpose of this study was to evaluate differences in outcomes among patients with severe alcohol withdrawal syndrome (AWS) who received symptom-monitored loading (SML) regimens of lorazepam, chlordiazepoxide, or gabapentin as compared to those who received Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised (CIWA-Ar)-based treatment alone during hospitalization.

This retrospective cohort study compared length of hospital stay between patients who received SML with CIWA-Ar-based treatment and those who received CIWA-Ar-based treatment only. Secondary outcomes included escalation of care, the lorazepam equivalents used from CIWA-Ar scoring, and the duration of the active alcohol withdrawal protocol. All-cause mortality and respiratory compromise were safety outcomes. Eligible patients were 18 years of age or older, had an active alcohol withdrawal order set from October 2021 to September 2023, and experienced severe alcohol withdrawal within 96 hours of admission.

The final analysis included 240 patient encounters in the SML + CIWA-Ar group and 198 patient encounters in the CIWA-Ar-only group. The primary outcome, average hospital length of stay, was significantly shorter in the SML + CIWA-Ar group than in the CIWA-Ar-only group (mean [SD]: 5.7 [6] days vs 8.4 [10.2] days; P < 0.001). Patients in the SML + CIWA-Ar group also had a significantly lower rate of mortality from any cause (10.7% vs 17.8%; P = 0.006), and a significantly lower proportion of patients in this group required respiratory support (5.4% vs 10.6%; P = 0.043).

This study found that patients with severe AWS who received SML dosing in addition to CIWA-Ar-based lorazepam had a shorter hospital length of stay and a decreased rate of all-cause mortality.