Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada.
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada; British Columbia Center for Substance Use, Vancouver, British Columbia, Canada.
Ann Emerg Med. 2020 Dec;76(6):774-781. doi: 10.1016/j.annemergmed.2020.05.029. Epub 2020 Jul 28.
Alcohol withdrawal is a common emergency department (ED) presentation. Although benzodiazepines reduce symptoms of withdrawal, there is little ED-based evidence to assist clinicians in selecting appropriate pharmacotherapy. We compare lorazepam with diazepam for the management of alcohol withdrawal to assess 1-week ED and hospital-related outcomes.
From January 1, 2015, to December 31, 2018, at 3 urban EDs in Vancouver, Canada, we studied patients with a discharge diagnosis of alcohol withdrawal. We excluded individuals presenting with a seizure or an acute concurrent illness. We performed a structured chart review to ascertain demographics, ED treatments, and outcomes. Patients were stratified according to initial management with lorazepam versus diazepam. The primary outcome was hospital admission, and secondary outcomes included in-ED seizures and 1-week return visits for discharged patients.
Of 1,055 patients who presented with acute alcohol withdrawal, 898 were treated with benzodiazepines. Median age was 47 years (interquartile range 37 to 56 years) and 73% were men. Baseline characteristics were similar in the 2 groups. Overall, 69 of 394 patients (17.5%) receiving lorazepam were admitted to the hospital compared with 94 of 504 patients receiving diazepam (18.7%), a difference of 1.2% (95% confidence interval -4.2% to 6.3%). Seven patients (0.7%; 95% confidence interval 0.3% to 1.4%) had an in-ED seizure, but all seizures occurred before receipt of benzodiazepines. Among patients discharged home, 1-week return visits occurred for 78 of 325 (24.0%) who received lorazepam and 94 of 410 (23.2%) who received diazepam, a difference of 0.8% (95% confidence interval -5.3% to 7.1%).
In our sample of ED patients with acute alcohol withdrawal, patients receiving lorazepam had an admission rate similar to that of those receiving diazepam. The few in-ED seizures occurred before medication administration. For discharged patients, the 1-week ED return visit rate of nearly 25% could warrant enhanced follow-up and community support.
酒精戒断是急诊常见的一种急症。尽管苯二氮䓬类药物可缓解戒断症状，但在为临床医生提供选择适当药物治疗方面，急诊缺乏相关证据。我们比较了劳拉西泮和地西泮在治疗酒精戒断方面的效果，以评估 1 周内急诊和医院相关结局。
2015 年 1 月 1 日至 2018 年 12 月 31 日，我们在加拿大温哥华的 3 所城市急诊中心研究了以酒精戒断为出院诊断的患者。我们排除了有癫痫发作或急性合并症的患者。我们进行了一项结构化图表审查，以确定人口统计学特征、急诊治疗和结局。患者根据初始接受劳拉西泮还是地西泮治疗进行分层。主要结局是住院，次要结局包括出院患者的急诊内癫痫发作和 1 周复诊。
在 1055 例急性酒精戒断患者中，898 例接受了苯二氮䓬类药物治疗。中位年龄为 47 岁（四分位间距 37 至 56 岁），73%为男性。两组患者的基线特征相似。总体而言，接受劳拉西泮治疗的 394 例患者中有 69 例（17.5%）住院，而接受地西泮治疗的 504 例患者中有 94 例（18.7%），差异为 1.2%（95%置信区间-4.2%至 6.3%）。有 7 例（0.7%；95%置信区间 0.3%至 1.4%）患者发生急诊内癫痫发作，但所有癫痫发作均发生在接受苯二氮䓬类药物之前。出院回家的患者中，接受劳拉西泮治疗的 325 例患者中有 78 例（24.0%）和接受地西泮治疗的 410 例患者中有 94 例（23.2%）在 1 周内返回急诊，差异为 0.8%（95%置信区间-5.3%至 7.1%）。
在我们的急性酒精戒断急诊患者样本中，接受劳拉西泮治疗的患者的住院率与接受地西泮治疗的患者相似。少数急诊内癫痫发作发生在用药前。对于出院的患者，近 25%的 1 周内急诊复诊率可能需要加强随访和社区支持。
