Zakhary Kirolos, Bruno Sophia, Myatt Caleb A, Perera Vindya, Saleh Kerolese, Smearman Jacob A, Yuzwa Madeline M, Soric Mate M, Zampino Stephanie
Northeast Ohio Medical University College of Pharmacy, 4209 State Route 44, Rootstown, Ohio, 44272.
Ohio State University Wexner Medical Center, 452 W 10th Avenue, Columbus, OH, 43210.
Innov Pharm. 2024 Aug 21;15(3). doi: 10.24926/iip.v15i3.6270. eCollection 2024.
Benzodiazepines are the mainstay treatment in Alcohol Withdrawal Syndrome (AWS), though they have the potential for abuse and cognitive side effects. Non-benzodiazepines are of growing interest for treatment of AWS; however, the prevalence of non-benzodiazepine use remains unknown. The purpose of this study is to evaluate the prevalence and predictors of non-benzodiazepine use for AWS in the Emergency Department (ED). A cross-sectional, retrospective study utilizing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning the years 2014-2020 investigated patients presenting to the ED with AWS. The primary outcome of this study is the prevalence of patients with AWS who received non-benzodiazepine treatment during their ED visit. The secondary outcome was the identification of predictor variables for non-benzodiazepine use. A multivariate logistic regression with a backward elimination approach was employed to identify predictor variables. A total of 2,300 unweighted ED visits included over the study years. When weighted, this represented over 15.2 million ED visits. Across the study period, 3.1% (95% CI, 1.6-6.1%) of patients received non-benzodiazepines. Positive predictors of non-benzodiazepine use included the year 2020 compared to 2014 (OR 6.32, 95% CI, 1.39-28.73) and comorbid depression (OR 4.13, 95% CI, 1.38-12.36). Negative predictors of non-benzodiazepine use included ages 18-40 compared to ages 41-64 (OR 0.34, 95% CI, 0.13-0.91), nursing home residence compared to private residence (OR 0.02, 95% CI, 0.001-0.80), and the South compared to the Midwest region of the United States (OR 0.19, 95% CI, 0.07- 0.51). This study found that non-benzodiazepine use, despite being less common, is becoming more prevalent. Further research is needed to determine the optimal dosing and duration of non-benzodiazepines for AWS. Understanding the factors influencing the prescription patterns of non-benzodiazepines can contribute to informed decision-making and improve the management of AWS.
苯二氮䓬类药物是酒精戒断综合征（AWS）的主要治疗药物，尽管它们有被滥用的可能性和认知方面的副作用。非苯二氮䓬类药物在AWS治疗中的应用越来越受到关注；然而，非苯二氮䓬类药物的使用 prevalence 仍然未知。本研究的目的是评估急诊科（ED）中用于AWS的非苯二氮䓬类药物的使用 prevalence 和预测因素。一项横断面回顾性研究利用了2014年至2020年期间美国国家医院门诊医疗调查（NHAMCS）的数据，调查了因AWS就诊于ED的患者。本研究的主要 outcome 是在ED就诊期间接受非苯二氮䓬类药物治疗的AWS患者的 prevalence。次要 outcome 是确定非苯二氮䓬类药物使用的预测变量。采用向后逐步回归的多变量逻辑回归来确定预测变量。在研究期间共纳入了2300次未加权的ED就诊。加权后，这代表了超过1520万次ED就诊。在整个研究期间，3.1%（95%CI，1.6 - 6.1%）的患者接受了非苯二氮䓬类药物治疗。非苯二氮䓬类药物使用的阳性预测因素包括与2014年相比的2020年（OR 6.32，95%CI，1.39 - 28.73）和合并抑郁症（OR 4.13，95%CI，1.38 - 12.36）。非苯二氮䓬类药物使用的阴性预测因素包括18 - 40岁与41 - 64岁相比（OR 0.34，95%CI，0.13 - 0.91）、居住在养老院与私人住宅相比（OR 0.02，95%CI，0.001 - 0.80）以及美国南部与中西部地区相比（OR 0.19，95%CI，0.07 - 0.51）。本研究发现，尽管非苯二氮䓬类药物的使用不太常见，但正变得越来越普遍。需要进一步研究以确定用于AWS的非苯二氮䓬类药物的最佳剂量和疗程。了解影响非苯二氮䓬类药物处方模式的因素有助于做出明智的决策并改善AWS的管理。
