SHM Converge Scientific Abstract ePoster Gallery-Comparison of Phenobarbital and Lorazepam Protocols for Inpatient Alcohol Withdrawal Syndrome; A Retrospective Cohort Study

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This retrospective cohort study compared a symptom-triggered lorazepam protocol with a fixed-dose phenobarbital protocol for alcohol withdrawal syndrome in non-ICU hospitalized patients at Nebraska Medicine. The authors reviewed 754 inpatient encounters from May 2022 to April 2023: 444 received lorazepam and 310 received phenobarbital.<br /><br />The main outcome was hospital length of stay, analyzed with backward stepwise regression to adjust for baseline differences. Secondary outcomes included ICU transfer, 30-day readmission, leaving against medical advice, restraint use, adjunct medication use, and need for oxygen.<br /><br />Results showed no statistically significant difference in adjusted mean hospital length of stay between groups: 3.87 days for lorazepam versus 4.15 days for phenobarbital (adjusted p = 0.301). Other adjusted outcomes were also similar. ICU transfer rates were 3.60% with lorazepam and 4.52% with phenobarbital; 30-day readmission was 24.55% versus 29.68%; restraint use, adjunct medication use, and oxygen requirement were also comparable. Leaving against medical advice was numerically lower in the phenobarbital group but did not reach statistical significance.<br /><br />A notable finding was frequent cross-over between protocols: 28.83% of patients in the lorazepam group also received phenobarbital, and 52.26% of patients in the phenobarbital group also received benzodiazepines.<br /><br />The authors conclude that, after adjustment for baseline differences, fixed-dose phenobarbital did not outperform symptom-triggered lorazepam for non-ICU alcohol withdrawal management. They note possible reasons for the null findings, including similar effectiveness, residual confounding, longer phenobarbital treatment duration, and exposure misclassification.

Asset Subtitle

Jason F. Shiffermiller

Meta Tag

Author List Alexandra Petersen, Jason F. Shiffermiller, Logan Olson

Category Research

Concept Phenobarbital

Concept Benzodiazepine

Concept Alcohol Withdrawal

Concept Hospital Length of Stay

Concept Non-ICU Hospitalization

Distinguished Non-Finalist

Presenter Organization University of Nebraska Medical Center

Presenting Author Jason F. Shiffermiller

Track Outcomes Research

Keywords

alcohol withdrawal syndrome

lorazepam

phenobarbital

retrospective cohort study

hospital length of stay

non-ICU patients

symptom-triggered protocol

fixed-dose protocol

ICU transfer

30-day readmission

Phenobarbital

Benzodiazepine

Alcohol Withdrawal

Hospital Length of Stay

Non-ICU Hospitalization