Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, USA; Department of Pharmacy Services, Banner - University Medical Center Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, USA.
Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, USA; Department of Pharmacy Services, Banner - University Medical Center South, 2800 E. Ajo Way, Tucson, AZ 85713, USA.
Am J Emerg Med. 2019 Jul;37(7):1313-1316. doi: 10.1016/j.ajem.2018.10.007. Epub 2018 Oct 11.
To compare a phenobarbital-adjunct versus benzodiazepine-only approach for the management of alcohol withdrawal syndrome in the emergency department (ED) with regard to the need for intensive care unit (ICU) admission, severity of symptoms on ED discharge, and complications.
This was a retrospective cohort study conducted in two academic EDs in the United States. Adult patients seen in the ED with a diagnosis of alcohol withdrawal syndrome were included. Patients were categorized into two groups based on whether phenobarbital was administered in the ED: 1) phenobarbital group (with or without benzodiazepines) or 2) non-phenobarbital group. The primary outcome measure was the need for ICU admission. Secondary outcomes included Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scores at ED discharge, and complications. Complications were a composite of death, need for intubation, hypotension or vasopressor use, seizures, and hospital acquired pneumonia.
The study cohort included 209 patients (phenobarbital = 97, non-phenobarbital = 112). The mean (standard deviation) age was 49 (12) years and 85% (n = 178) were male. A similar proportion of patients in the phenobarbital (14%, n = 14) and non-phenobarbital (11%, n = 12) groups required ICU admission (p = 0.529). The median CIWA-Ar score on ED discharge was 7 (IQR 4-12) points in the phenobarbital group and 7 (IQR 4-14) points in the non-phenobarbital group (p = 0.752). The occurrence of complications was also similar in the phenobarbital (9%, n = 9) and non-phenobarbital groups (11%, n = 10).
Adjunctive phenobarbital use in the ED for alcohol withdrawal syndrome did not result in decreased ICU admission, severity of symptoms, or complications.
比较苯巴比妥辅助与仅用苯二氮䓬类药物治疗急诊科（ED）酒精戒断综合征患者在 ICU 入院、ED 出院时症状严重程度和并发症方面的差异。
这是在美国两家学术性 ED 进行的回顾性队列研究。纳入在 ED 就诊且诊断为酒精戒断综合征的成年患者。根据 ED 是否给予苯巴比妥，患者分为两组：1）苯巴比妥组（用或不用苯二氮䓬类药物）或 2）非苯巴比妥组。主要结局指标为 ICU 入院需求。次要结局指标包括 ED 出院时的临床戒断评估酒精量表（CIWA-Ar）评分和并发症。并发症包括死亡、需要插管、低血压或血管加压药使用、癫痫发作和医院获得性肺炎的复合结局。
研究队列包括 209 例患者（苯巴比妥组=97 例，非苯巴比妥组=112 例）。患者的平均（标准差）年龄为 49（12）岁，85%（n=178）为男性。苯巴比妥组（14%，n=14）和非苯巴比妥组（11%，n=12）患者需要 ICU 入院的比例相似（p=0.529）。苯巴比妥组 ED 出院时的 CIWA-Ar 评分中位数为 7（四分位距 4-12）分，非苯巴比妥组为 7（四分位距 4-14）分（p=0.752）。苯巴比妥组（9%，n=9）和非苯巴比妥组（11%，n=10）并发症的发生率也相似。
ED 中使用苯巴比妥辅助治疗酒精戒断综合征并未降低 ICU 入院率、症状严重程度或并发症发生率。
