Symptoms-Triggered Approach versus Fixed-Scheduled Approach of Benzodiazepines for Management of Alcohol Withdrawal Syndrome: Non-Randomized Controlled Trial

Link to article at PubMed

Alcohol. 2022 Oct 11:S0741-8329(22)00098-2. doi: 10.1016/j.alcohol.2022.09.004. Online ahead of print.


BACKGROUND: Alcohol withdrawal syndrome, if untreated, can lead to potentially life-threatening complications. Benzodiazepines are the drugs of choice for the treatment of alcohol withdrawal syndrome. We aimed to compare the symptoms-triggered approach and fixed-dose approach of benzodiazepines administration for treatment of alcohol withdrawal syndrome in regards to the health care utilization measured by the total dose of benzodiazepines, length of hospital stays, and 90-day readmissions rate.

METHODS: A single-centre prospective non-randomized controlled trial included all patients diagnosed with alcohol withdrawal syndrome. The group of patients admitted between 1st October 2019 and 30th September 2020 were treated with the fixed-scheduled approach (n=150), while all patients admitted between 1st November 2020 to 31st October 2021 were treated with the symptoms-trigger approach (n=50).

RESULTS: Fixed-dose approach group showed a significant higher 90-days readmissions rate (HR 2.61;95% CI =1.18, 6.84; p=0.01). Kaplan-Meier survival analysis showed a significantly shorter duration to the first readmission in the fixed-scheduled approach group (HR:2.3;95% CI: 5.6,1.16; p=0.02). Symptoms-triggered approach group required a significantly lower dose of diazepam (40 mg vs 10 mg; p<0.01) and a higher dose of thiamine (800 mg vs 600 mg; p<0.01). Length of hospital stay was significantly increased in the symptoms-triggered approach group (3.9 vs 2.2; days); p<0.01).

DISCUSSION: The use of a symptoms-triggered approach to treat alcohol withdrawal syndrome was associated with a lower 90-day readmission rate, prolonged period to the first readmission, and reduced total dose of benzodiazepines, but longer length of hospital stay.

CONCLUSION: Symptoms-triggered approach is safe, cost-effective, and associated with reduced alcohol dependence relapse.

PMID:36240945 | DOI:10.1016/j.alcohol.2022.09.004

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