Experience With an Adult Alcohol Withdrawal Syndrome Practice Guideline in Internal Medicine Patients

Karen M. Stanley, MS; Cathy L. Worrall, PharmD, FAPhA; Shayna L. Lunsford, MS; Kit N. Simpson, Dr.PH; Justin G. Miller, MD; Anne P. Spencer, PharmD


Pharmacotherapy. 2005;25(8):1073-1083. 

In This Article


A total of 81 internal medicine patients (32 pilot, 49 control) were included in the data analysis. The pilot and control groups did not differ significantly with respect to mean age and race or ethnicity. Significantly more men were in the control group than in the pilot group (p=0.02; Table 1 ).

Pilot patients received significantly less lorazepam (p=0.001) and significantly more clonidine (p=0.01) and haloperidol (p=0.002) than controls. Significantly more pilot patients (19%) than controls (2%) required no drug therapy to manage or prevent symptoms of alcohol withdrawal (p=0.01). Excluding these patients from the analysis of amount of drug administered did not change the statistical significance of these findings. Significantly more controls (71.4%) than pilot patients (18.8%) were discharged with tapered benzodiazepine therapy (p<0.01; Table 2 ).

Pilot and control groups did not differ significantly with respect to adverse events. One patient in each group experienced an alcohol withdrawal seizure (p=0.76). A 12-lead electrocardiogram (ECG) was documented for 18 (56%) pilot patients before haloperidol therapy was begun and for 29 (59%) controls during their hospital stay. In these patients, a prolonged QTc interval (> 450 msec) was noted in 13 (72%) pilot patients and eight (28%) controls (p≤0.01). No patients experienced cardiovascular events or were transferred to an intensive care unit.

A sitter was needed for one pilot patient (3%), whereas the comparison group required a sitter for six (12%) patients (p=0.23). Use of restraints was similar for both groups—nine (28%) pilot patients and 13 controls (27%) (p=0.87). No significant differences between groups were found for LOS. Multivariate analysis of LOS (controlling for expected LOS, age, race or ethnicity, and sex) and analysis of the data using the Heckman transformation to control for possible selection bias confirmed no difference in the LOS between groups ( Table 3 ).


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