818: THE IMPACT OF A BENZODIAZEPINE-SPARING STRATEGY ON ALCOHOL WITHDRAWAL MANAGEMENT

Abstract

Introduction: The objective of this study was to assess the impact of a benzodiazepine-sparing strategy on overall benzodiazepine use in alcohol withdrawal management. Commonly utilized agents in benzodiazepine-sparing strategies include clonidine, gabapentin, and dexmedetomidine. These agents are less potent than benzodiazepines individually, but literature reveals using higher doses and combinations of these agents to target multiple pathways may provide similar efficacy with less adverse events. Methods: This is a chart review of trauma and surgical patients at a large, community hospital. Patients managed for alcohol withdrawal prior to implementation of a benzodiazepine-sparing protocol were compared to patients managed post-implementation of a protocol. Those included had a Prediction of Alcohol Withdrawal Severity Scale (PAWSS) score ≥ 4 or clinical suspicion of alcohol withdrawal. The primary outcome was decreased overall benzodiazepine use in lorazepam equivalents in milligrams. Secondary outcomes evaluated duration of alcohol withdrawal symptoms and adverse effects. Descriptive statistics were utilized to analyze primary and secondary outcomes as well as baseline characteristics. Propensity matching was performed using IBM SPSS Statistics version 25.0 (IBM Inc., Armonk, NY). Results: A total of 25 patients received a benzodiazepine-sparing strategy and 159 patients were in the control group. The intervention arm required a median of 2 mg [IQR: 0, 14] of benzodiazepines (lorazepam equivalents) compared to the control arm who required a median of 10 mg [IQR: 2, 28]. Propensity matching yielded similar results with the intervention arm receiving a median of 8 mg [IQR: 2, 25] of benzodiazepines (lorazepam equivalents) versus a median of 13 mg [IQR: 9, 37]) in the control arm. The intervention arm experienced alcohol withdrawal symptoms for a median of 1 day [IQR: 0,6]; whereas, the control arm experienced symptoms for a median of 5 days [IQR: 0, 4]. Conclusions: Utilization of a benzodiazepine-sparing strategy was associated with a reduction in overall benzodiazepine exposure. The results of this study implicate a need for further robust trials to establish the safety of benzodiazepine-sparing protocols and the ability to improve clinically meaningful outcomes.