Department of Emergency Medicine, University of California, San Francisco, 1001 Potrero Ave, Building 5, Room 2C8, Box 1369, San Francisco, CA, 94143, USA.
J Med Toxicol. 2022 Jan;18(1):4-10. doi: 10.1007/s13181-021-00863-2. Epub 2021 Oct 25.
Phenobarbital has been successfully used in the emergency department (ED) to manage symptoms of alcohol withdrawal, but few studies have reported outcomes for ED patients who receive phenobarbital and are discharged. We compared return encounter rates in discharged ED patients with alcohol withdrawal who were treated with benzodiazepines and phenobarbital.
This is a retrospective cohort study conducted at a single academic medical center utilizing chart review of discharged ED patients with alcohol withdrawal from July 1, 2016, to June 30, 2019. Patients were stratified according to ED management with benzodiazepines, phenobarbital, or a combination of both agents. The primary outcome was return ED encounter within three days of the index ED encounter. Multivariate logistic regression identified significant covariates of an ED return encounter.
Of 470 patients who were discharged with the diagnosis of alcohol withdrawal, 235 were treated with benzodiazepines, 133 with phenobarbital, and 102 with a combination of both. Baseline characteristics were similar among the groups. However, patients who received phenobarbital were provided significantly more lorazepam equivalents compared to patients who received benzodiazepines alone. Treatment with phenobarbital, alone or in combination with benzodiazepines, was associated with significantly lower odds of a return ED visit within three days compared with benzodiazepines alone [AOR 0.45 (95% CI 0.23, 0.88) p = 0.02 and AOR 0.33 (95% CI 0.15, 0.74) p = 0.007].
Patients who received phenobarbital for alcohol withdrawal were less likely to return to the ED within three days of the index encounter. Despite similar baseline characteristics, patients who received phenobarbital, with or without benzodiazepines, were provided greater lorazepam equivalents the ED.
苯巴比妥已成功用于急诊科（ED）来缓解酒精戒断症状，但很少有研究报道接受苯巴比妥治疗并出院的 ED 患者的结局。我们比较了接受苯二氮䓬类药物和苯巴比妥治疗的酒精戒断性 ED 患者出院后的再次就诊率。
这是一项在单家学术医疗中心进行的回顾性队列研究，利用 2016 年 7 月 1 日至 2019 年 6 月 30 日期间 ED 出院的酒精戒断患者的病历回顾。患者根据 ED 管理方式分为苯二氮䓬类药物、苯巴比妥或两者联合治疗。主要结局为在 ED 就诊后 3 天内再次 ED 就诊。多变量逻辑回归确定了 ED 再次就诊的显著协变量。
在 470 例被诊断为酒精戒断并出院的患者中，235 例接受了苯二氮䓬类药物治疗，133 例接受了苯巴比妥治疗，102 例接受了两者联合治疗。各组的基线特征相似。然而，与单独接受苯二氮䓬类药物治疗的患者相比，接受苯巴比妥治疗的患者给予的劳拉西泮等效剂量明显更高。与单独使用苯二氮䓬类药物相比，单独使用或联合使用苯巴比妥治疗与在 3 天内再次 ED 就诊的可能性显著降低相关[比值比（OR）0.45（95%可信区间 0.23，0.88），p=0.02 和 OR 0.33（95%可信区间 0.15，0.74），p=0.007]。
接受苯巴比妥治疗酒精戒断的患者在指数就诊后 3 天内再次到 ED 就诊的可能性较低。尽管基线特征相似，但接受苯巴比妥治疗（联合或不联合苯二氮䓬类药物）的患者在 ED 获得的劳拉西泮等效剂量更大。
