Section of Medical Toxicology, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, Aurora, Colorado.
J Emerg Med. 2024 Apr;66(4):e516-e522. doi: 10.1016/j.jemermed.2023.12.007. Epub 2023 Dec 14.
Phenobarbital has been used in the emergency department (ED) as both a primary and adjunctive medication for alcohol withdrawal, but previous studies evaluating its impact on patient outcomes are limited by heterogenous symptom severity.
We compared the clinical outcomes of ED patients with moderate alcohol withdrawal who received phenobarbital, with or without benzodiazepines, with patients who received benzodiazepine treatment alone.
This is a retrospective cohort study conducted at a single academic medical center utilizing chart review of ED patients with moderate alcohol withdrawal between 2015 and 2020. Patient encounters were classified into two treatment categories based on medication treatment: phenobarbital alone or in combination with benzodiazepines vs. benzodiazepines alone. Chi-square test or Fisher's exact was used to analyze categorical variables and the Student's t-test for continuous data.
Among the 287 encounters that met inclusion criteria, 100 received phenobarbital, compared with 187 that received benzodiazepines alone. Patients who received phenobarbital were provided significantly more lorazepam equivalents. There was a significant difference in the percentage of patient encounters that required admission to the hospital in the phenobarbital cohort compared with the benzodiazepine cohort (75% vs. 43.3%, p < 0.001). However, there was no difference in admission level of care to the floor (51.2% vs. 52.0%), stepdown (33.8% vs. 28%), or intensive care unit (15% vs. 20%), respectively.
Patients who received phenobarbital for moderate alcohol withdrawal were more likely to be admitted to the hospital, but there was no difference in admission level of care when compared with patients who received benzodiazepines alone. Patients who received phenobarbital were provided greater lorazepam equivalents in the ED.
苯巴比妥已在急诊科（ED）中被用作酒精戒断的主要和辅助药物，但以前评估其对患者结局影响的研究受到症状严重程度不同的限制。
我们比较了接受苯巴比妥（单独或联合苯二氮䓬类药物）与单独接受苯二氮䓬类药物治疗的中度酒精戒断 ED 患者的临床结局。
这是一项在单一学术医疗中心进行的回顾性队列研究，利用 2015 年至 2020 年期间中度酒精戒断 ED 患者的图表审查。根据药物治疗将患者就诊分为两类：单独使用苯巴比妥或与苯二氮䓬类药物联合使用与单独使用苯二氮䓬类药物。使用卡方检验或 Fisher 精确检验分析分类变量，使用学生 t 检验分析连续数据。
在符合纳入标准的 287 次就诊中，100 次就诊接受了苯巴比妥治疗，而 187 次就诊仅接受了苯二氮䓬类药物治疗。接受苯巴比妥治疗的患者接受了更多的劳拉西泮等效物。与苯二氮䓬类药物组相比，苯巴比妥组需要住院的患者就诊比例有显著差异（75% vs. 43.3%，p < 0.001）。然而，入住普通病房（51.2% vs. 52.0%）、下转（33.8% vs. 28%）或重症监护病房（15% vs. 20%）的患者比例无差异。
接受苯巴比妥治疗中度酒精戒断的患者更有可能住院，但与单独接受苯二氮䓬类药物治疗的患者相比，其住院治疗水平无差异。接受苯巴比妥治疗的患者在 ED 中接受了更多的劳拉西泮等效物。
