786: IMPACT OF FRONT-LOADING PHENOBARBITAL CUMULATIVE DOSE AND ICU ADMISSION FOR ALCOHOL WITHDRAWAL

Abstract

Introduction: Alcohol withdrawal syndrome is a common reason for hospitalization and progression to severe alcohol withdrawal is associated with ICU admission. Recent evidence suggests symptom triggered use of phenobarbital in the ED is associated with reductions in ICU admission, duration of mechanical ventilation, and hospital length of stay. The objective of our study is to identify if larger cumulative phenobarbital doses in the ED are associated with ICU admission in the absence of strict ICU admission criteria (e.g. mechanical ventilation, hemodynamically unstable). Methods: This was a single center, retrospective analysis of patients with alcohol withdrawal, given symptom triggered doses of phenobarbital in the ED, and subsequently admitted to ICU or non-ICU care areas. We compared cumulative doses of phenobarbital administered in the ED and if higher doses were associated with ICU admission. Secondary outcomes included occurrence of seizure and hospital length of stay. Risk factors for ICU admission were assessed in univariate analyses and multivariable modeling. Results: 200 patients were included (100 ICU and 100 non-ICU) in the study. There was no significant difference in cumulative phenobarbital doses received in the ED between patients admitted to ICU or non-ICU areas (811 mg vs. 780 mg, p=0.6). Secondary outcomes were similar between the groups except a longer hospital length of stay in the ICU group (5.4 days vs 3.6 days, p=0.04). Multivariable analysis identified higher average ED symptom triggered alcohol withdrawal scores (SEWS, aOR 1.44, 95% CI 1.26-1.64, p< 0.0001) and positive blood alcohol concentration on admission (aOR 2.01, 95% CI 1.04-3.89, p=0.04) as predictors of ICU admission. Conclusions: There was no difference in cumulative phenobarbital requirements in patients who were admitted to ICU or non-ICU areas for alcohol withdrawal. Additional risk factors such as higher alcohol withdrawal score and positive blood alcohol concentration may be predictors of more severe withdrawal needing ICU level of care. Additional prospective studies are needed to identify predictors of severe alcohol withdrawal syndrome.