SHM Converge Scientific Abstract ePoster Gallery-Phenobarbital Monotherapy for Alcohol Withdrawal Syndrome: Implementation and Outcomes

Pdf Summary

This study evaluated implementation of a phenobarbital (PB) monotherapy protocol for alcohol withdrawal syndrome (AWS) at a community campus of a university hospital. PB was chosen because it acts on both GABA and glutamate pathways, uses weight-based dosing, and may have a lower delirium risk than benzodiazepines (BZDs).<br /><br />Researchers retrospectively compared patients admitted with AWS during 11 months before and 11 months after an electronic health record PB order set was introduced. They also compared post-implementation patients treated with PB versus those treated with the traditional BZD protocol.<br /><br />After rollout, the PB protocol was used in 76% of eligible patients. Pre- and post-change groups were similar in age, sex, blood alcohol level, withdrawal history, illness severity, and need for ICU care or ventilation. Overall, symptoms improved faster after implementation: maximum CIWA scores were lower on days 2 and 3, and hospital length of stay was 19% shorter. In the post-implementation analysis, patients receiving PB had higher initial withdrawal severity and higher severity-of-illness scores than BZD-treated patients, yet showed a trend toward faster symptom improvement and shorter stays. The protocol was used safely outside the ICU, with no increase in ICU admissions or ventilator use and no observed adverse events or PB toxicity.<br /><br />The authors conclude that PB monotherapy can be safely implemented for AWS in acute care and ICU settings and may lead to faster symptom resolution and shorter hospitalization. They note, however, that the study is limited by its retrospective design, including potential selection bias and confounding.

Asset Subtitle

Benjamin J. Wolpaw

Meta Tag

Author List Benjamin J. Wolpaw, Hannah Oren, Kyle Sears, Laura Quinnan-Hostein, Marion A. Granich, Mark A. Cortezzo, Tessa L. Steel

Category Research

Concept Phenobarbital

Concept Alcohol Withdrawal Syndrome

Concept Benzodiazepine

Concept CIWA

Concept Monotherapy

Distinguished Non-Finalist

Presenter Organization University of Washington Medical Center - Northwest Campus

Presenting Author Benjamin J. Wolpaw

Track Quality Improvement

Keywords

phenobarbital

alcohol withdrawal syndrome

monotherapy protocol

benzodiazepines

GABA

glutamate

electronic health record

CIWA scores

hospital length of stay

retrospective study

Phenobarbital

Alcohol Withdrawal Syndrome

Benzodiazepine

CIWA

Monotherapy