Journal article
Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study
Journal of addiction medicine, Vol.18(4), pp.389-396
07/2024
DOI: 10.1097/ADM.0000000000001297
PMID: 38452185
Abstract
Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM).
We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse. Inpatient management and hospital outcomes were obtained by chart review. Factors associated with treatment duration and complicated withdrawal were examined.
Of the 594 patients included in this study, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone. The most common medication given was lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%), and phenobarbital (6%). Symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57-0.80) and front loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62-0.92) were associated with reduced treatment duration. Lorazepam (RR, 1.20; 95% CI, 1.02-1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06-1.54) were associated with increased treatment duration. Lorazepam (adjusted odds ratio, 4.30; 95% CI, 1.05-17.63) and phenobarbital (adjusted odds ratio, 6.51; 95% CI, 2.08-20.40) were also associated with complicated withdrawal.
Overall, our results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. Health care systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations.
Details
- Title: Subtitle
- Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study
- Creators
- Matthew V RonanKirsha S GordonMelissa SkandersonMichael KrugPatrick GodwinDaniel HeppeMatthew HoeghJoel C BogganJeydith GutierrezPeter KaboliMicah PescettoMichelle GuidryPeter CaldwellChristine MitchellErik EhlersNazima AllaudeenJessica CyrAndrea SmeraglioPeter YarbroughRichard RoseAnand JagannathJaclyn VargasPaul B CorniaMeghna ShahMatthew TuckCherinne ArundelJames LaudateJoel ElzweigBenjamin RodwinJoyce AkweMeredith TrubittCraig G Gunderson
- Resource Type
- Journal article
- Publication Details
- Journal of addiction medicine, Vol.18(4), pp.389-396
- DOI
- 10.1097/ADM.0000000000001297
- PMID
- 38452185
- NLM abbreviation
- J Addict Med
- eISSN
- 1935-3227
- Language
- English
- Electronic publication date
- 03/07/2024
- Date published
- 07/2024
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984567868302771
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