Penn State Health Milton S. Hershey Medical Center, Pennsylvania
Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: This study aims to assess the impact of an updated phenobarbital protocol for alcohol withdrawal. The changes include adding an oral loading dose for mild to moderate withdrawal and the removal of ICU requirements for severe withdrawal.
Methods: This is a retrospective cohort study comparing two different phenobarbital protocols. Previously, patients being treated for severe withdrawal were required to be admitted to an ICU and could be downgraded after five hours. Now patients can receive the IV loading doses in the emergency department or ICU and then be admitted to an intermediate care unit. Patients being treated for mild to moderate withdrawal can now receive an oral loading dose before starting a standardized taper. Patients were included if they were at least 18 years old, were ordered phenobarbital for the treatment of alcohol withdrawal and received at least one dose. The co-primary endpoints were ICU admissions and ICU length of stay. Safety outcomes included intubation rates, administration of sedatives infusions or antipsychotics, and 30-day readmissions rates. Categorical data was compared using a chi-squared test with an alpha of 0.05. Continuous data was reported using descriptive statics.
Results: A total of 246 patients were identified, 32 were excluded as they did not receive phenobarbital, and 214 patients were included. There were 114 patients treated with the original protocol and 100 patients with the updated protocol. While the updated protocol demonstrated lower rates of ICU admissions compared to the original protocol, this difference was not found to be statistically significant (37% vs 49%, p-value 0.07). ICU lengths of stay were similar (45.9 hours vs 38.3 hours) and there were no significant differences in safety outcomes between the two groups.
Conclusions: The updated phenobarbital protocol resulted in no statistically significant difference in ICU admissions or ICU length of stay. While the difference was not statically significant, it may be clinically meaningful. The aim of the new protocol was to decrease ICU requirements, and there was a 12.1% decrease in ICU admissions. The observed difference may have been statistically significant with a larger sample size. Overall, the new protocol demonstrated a similar safety profile with possibly less ICU utilization.
