The Efficacy of an Oral Diazepam Based Protocol in Improving Care and Reducing Duration of Hospitalization in Alcohol Withdrawal
John Chronakos
Department of Pulmonary and Critical Care Medicine, Danbury Hospital, Danbury, USA.
Aashutosh Ramakar
Department of Internal Medicine, Danbury Hospital, Danbury, Connecticut, USA.
Rutvik Shah
Department of Internal Medicine, Danbury Hospital, Danbury, Connecticut, USA.
Ahmad Alharbi
Department of Internal Medicine, Danbury Hospital, Danbury, Connecticut, USA and Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
Rahila Ogunnaike *
Department of Internal Medicine, Danbury Hospital, Danbury, Connecticut, USA.
Eman Hurissi
Faculty of Medicine, Jazan University, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Background: Complications from alcohol abuse are the fourth leading preventable cause of death in the United States. Hospital length of stay (LOS) for patients experiencing alcohol withdrawal syndrome (AWS) has become of particular concern and effective treatment protocols are needed.
Objective: At Danbury Hospital, a 371-bed community hospital in Danbury, Connecticut, the average LOS for AWS was historically nine days. We therefore designed a protocol for the treatment of AWS to provide effective treatment and thereby reduce LOS.
Design: Our study was a single centre, retrospective observational study of patients who were admitted to Danbury Hospital with a diagnosis of AWS.
Setting: Danbury Hospital.
Subjects and Methods: A total of 307 patients were included in this study. All patients 18 years and older admitted to Danbury Hospital between June 2015 and December 2016, with a primary diagnosis of AWS were included. A loading dose regimen was used whereby 20mg of oral Diazepam was given hourly for a total of eight doses within the first 24 hours until clinical improvement or mild sedation was achieved. The comparison group consisted of patients treated with a symptom-triggered regimen using Lorazepam.
We compared the primary outcome of LOS and secondary outcomes including need for transfer to a critical care unit, restraint use for aggressive behaviour related to withdrawal, the need for a safety companion, and the need for Psychiatry consultation between the two groups.
Main Outcome Measures: Hospital length of stay for patients experiencing alcohol withdrawal syndrome.
Results: In the Diazepam group versus the comparison group, LOS was reduced to about four days, and fewer Psychiatry consultations were needed.
Conclusion: We conclude that a loading dose regimen of Diazepam may be used to safely reduce LOS in AWS patients.
Keywords: Alcohol withdrawal delirium, diazepam, lorazepam, length of stay