Implementation of a Symptom-Triggered Benzodiazepine Protocol for Alcohol Withdrawal in Family Medicine Inpatients

Purpose: The purpose of this pilot study was to review the implementation of symptom-triggered benzodiazepine therapy and evaluate the feasibility and outcomes as compared with a previous hospital standard of fixed-dose phe- nobarbital protocol for alcohol withdrawal on a family medicine service. Methods: This retrospective chart review of 46 patients' medical records was performed on admissions to the fam- ily medicine service occurring between February and October of 2005 compared with February and October of 2006. Included in the study were adults who were suffering from alcohol withdrawal symptoms (AWS), who admit- ted to heavy daily alcohol intake, who were intoxicated on admission, and who had a history of AWS and/or histo- ry of AWS-related seizures. The Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) was used to evaluate the impact of individualized symptom-triggered therapy on outcome measurements utilizing symp- tom-triggered benzodiazepine therapy compared with the previous hospital standard using a fixed-dose phenobar- bital protocol. Results: One hundred percent of the patients in the phenobarbital group required drug compared with 38% in the benzodiazepine group (P < 0.001). Fewer patients (9.5%) in the benzodiazepine group left the hospital against med- ical advice (AMA), while 36% of patients in the phenobarbital group left AMA (P = 0.045). There was no signifi- cant difference in length of stay or the number of days on the protocol. Conclusion: The results of the pilot study demonstrated that symptom-triggered therapy using benzodiazepines resulted in better outcomes than fixed-dosing phenobarbital. Importantly, most patients in the benzodiazepine group required no drug administration.