Symptom-triggered dosing leads to lower total benzodiazepine dose and shorter hospital stay than fixed-tapered dosing.

In a retrospective chart review, researchers compared outcomes between 49 patients who received symptom-triggered benzodiazepine dosing and 50 who received standard fixed-tapered dosing for treatment of alcohol withdrawal in an emergency department (ED) clinical decision unit in Ireland during a 2-year period. Patients treated with the symptom-triggered dose regimen were assessed at 90-minute intervals using the Clinical Institute Withdrawal Assessment for Alcohol scoring tool and were given a dose of a benzodiazepine if the score indicated need. Patients treated with the standard regimen received tapered doses of benzodiazepine over 5 to 7 days. Benzodiazepine doses were reported in diazepam dosing equivalents, with 25 mg of chlordiazepoxide considered equivalent to 10 mg of diazepam.

The two groups were comparable in demographics, alcohol use, and reasons for coming to the ED. The symptom-triggered dosing group had a shorter median hospital stay (2 days vs. 3 days) and received a lower median cumulative benzodiazepine dose (equivalent to 80 mg vs. 170 mg of diazepam).

Comment: Many emergency physicians have already adopted the practice of treating alcohol withdrawal based on symptoms with the goal of the patient being calm but able to be aroused. This study suggests that this approach may not only reduce the amount of benzodiazepine needed, but it may also shorten hospital stay.

Source: Journal Watch Emergency Medicine