787: STANDARDIZING PHENOBARBITAL USE IN ALCOHOL WITHDRAWAL SYNDROME FOR A MULTIHOSPITAL SYSTEM

Abstract

Introduction: Phenobarbital (PHB) use in the treatment of alcohol withdrawal syndrome (AWS) has become common in clinical practice despite the lack of dosing standardization and when to initiate PHB. Recently, clinical trials have evaluated PHB as a safe and effective alternative to benzodiazepines (BZD). The ASAM Guidelines on Alcohol Withdrawal Management recommend the use of PHB only by clinicians experienced in its use and where extensive monitoring may occur. PHB is listed as an alternative to BZDs for severe AWS, but otherwise is only recommended in patients with a contraindication to BZDs. The objective of this project is to assess PHB use to determine a standardized dosing recommendation for patients experiencing AWS, leading to an improved understanding of PHB resulting in improved outcomes. Methods: This retrospective, multicenter, observational cohort included patients ≥18 years of age admitted to 16 AAH hospitals in WI and IL between June 4, 2021 to August 30, 2021 who received PHB for the treatment of AWS. Clinical data was extracted from the electronic medical record by chart review including comorbid conditions, PHB form and dose, CIWA scores before and 24 hours after PHB administration, and total concomitant BZD use. The primary outcome was improvement in median CIWA score after PHB administration while secondary outcomes included admission to the ICU, intubation, and death. Results: 100 patients were included. Improvement in median CIWA score after PHB occurred in both moderate and severe initial CIWA scores. Median severe initial CIWA scores decreased from 23 to 7 about 24 hours after PHB and median moderate initial CIWA scores decreased from 12 to 4 about 24 hours after PHB. Looking at where PHB orders were placed, 56 orders were in the ICU, 15 orders were in the ED, and the remaining placed on a general medicine floor. Prior to PHB, 18 patients were intubated with only 3 patients needing intubation after PHB. Only 4 patients who received PHB died with 2 related to a cancer diagnosis and the remaining 2 unrelated to AWS. Conclusions: The project concluded there was a decrease in CIWA scores after PHB in both moderate and severe AWS with the largest reduction in CIWA scores seen in patients with severe AWS. Earlier phenobarbital was associated with lower BZD use.