Evaluation of a symptom-triggered protocol approach to the management of alcohol withdrawal syndrome in older adults.

OBJECTIVES

To evaluate whether implementation of symptom-triggered administration of a benzodiazepine protocol reduces the severity (total cumulative dose), duration, and complications of alcohol withdrawal syndrome (AWS).

DESIGN

Retrospective health record review.

SETTING

Tertiary care center in Vancouver, Canada.

PARTICIPANTS

Individuals aged 70 and older admitted to the Acute Care for Elders and Acute Medicine Unit wards with diagnostic codes for AWS from 2008 to 2012.

MEASUREMENTS

Median duration and cumulative dose of benzodiazepine treatment, number of severe AWS complications, severe benzodiazepine-associated adverse effects, and need for adjunct therapy.

RESULTS

Thirty-three participants in the preprotocol group and 30 in the protocol-implemented group met the inclusion criteria. Median duration of benzodiazepine treatment decreased from 96 hours (interquartile range (IQR) 72-120 hours) in the preprotocol period to 48 hours (IQR 0-108 hours; P=.04), and median cumulative benzodiazepine dose administered decreased from 9 mg (IQR 5-19.8 mg) to 3 mg (IQR 0-10 mg; P=.001). Statistically significantly lower incidence of severe AWS complications (P=.007) and adjunct therapy use (P=.02) was seen in the protocol-implemented group.

CONCLUSION

A symptom-triggered protocol for dosing of benzodiazepine therapy in the management of AWS in individuals aged 70 and older significantly reduced the total duration of benzodiazepine use, cumulative benzodiazepine dose, and use of adjunctive medications in the treatment of AWS.