Outcomes after implementation of an alcohol withdrawal protocol at a single institution

Introduction: There are varying dosing strategies for the administration of benzodiazepines (BZD) in the setting of alcohol withdrawal. In October 2014, a symptom – based alcohol withdrawal protocol (AWP) using the Clinical Institute Withdrawal Assessment of Alcohol, Revised (CIWA-Ar) scale was implemented at one institution. Objectives: This study evaluated the safety and efficacy of the AWP. Study Design: This study utilized a retrospective chart review. Methods: Retrospective chart review was completed, including patients receiving at least one dose of diazepam for alcohol withdrawal pre- and post-protocol. The primary outcome of this study was the average daily and cumulative dose of diazepam during hospital stay. Secondary outcomes include length of stay, and occurrence of seizures of delirium tremens. Results: The average daily dose and the average cumulative dose of diazepam were significantly lower in the post-protocol group (5.4 vs 12.1mg, p < 0.001 and 35.0 vs 77.6mg, p < 0.001, respectively). Length of stay was similar between groups (6.5 vs 6.4 days, p = 0.91), however, duration of benzodiazepine use was decreased in the post-protocol group (2.2 vs 4.7 days, p < 0.001). Despite using reduced doses of benzodiazepines, there was no increase in adverse events. Conclusions: The implementation of a symptom – based AWP using the CIWA – Ar scale was associated with a reduced average daily and cumulative dose of diazepam without any apparent safety issues.