(61) Impact of an Alcohol Withdrawal Screening and Treatment Protocol for Hospitalized Patients

Introduction: Alcohol Use Disorder (AUD) remains common both in the United States and worldwide, with lifetime prevalence rates estimated to be around 29%. Alcohol Withdrawal Syndrome (AWS) is a potentially life-threatening complication of AUD that can be challenging to recognize in hospitalized patients. In efforts to eliminate provider bias, our institution implemented universal AUD screening for all patients admitted to a non-critical care venue using the validated Prediction of Alcohol Withdrawal Severity Scale (PAWSS). Patients at risk for withdrawal are then further assessed, utilizing the validated Glasgow Modified Alcohol Withdrawal Scale (GMAWS) at regular intervals, and medicated according to a predetermined symptom-triggered protocol with standardized benzodiazepine doses to treat withdrawal. This study sought to determine whether this protocol facilitated prompt recognition of alcohol withdrawal syndrome at Cooper University Hospital, decreased hospital length of stay, lowered the total dose of benzodiazepines, and decreased adverse events attributable to AWS.

Methods: This retrospective chart review was conducted over a 6-year period from 2014 to 2020. Patients with an ICD-10 code diagnosis of AWS were included and subsequently divided into two groups: pre-protocol introduction (March 2014- November 2017) or post-protocol introduction (January 2018-March 2020) with a one-month period for protocol integration. The specific outcome measures of benzodiazepine dosage, length of stay, and adverse events were compared pre- versus post-protocol introduction. Statistical analyses utilized Mann Whitney U test, Independent t test, Chi Square testing and linear regression analysis.

Results: This study included 248 patient encounters in the pre-protocol group and 420 patient encounters in the post-protocol group. There was no statistically significant difference in median length of stay between the two groups (2.9 days post-protocol and 3.1 days pre-protocol, p= 0.135). In the post-protocol group, there was a statistically significant reduction in the median benzodiazepine dose (13.9 mg and 11 mg lorazepam equivalents in the pre-protocol and post-protocol group, respectively, p < 0.001) and in occurrence of delirium tremens (6.9% pre-protocol and 1.7% post-protocol, p < 0.001).

Conclusion: Protocol implementation to both diagnose and treat AWS did not reduce hospital length of stay in patients with AUD. However, these protocols were associated with a significant reduction in both total benzodiazepine dose and progression to delirium tremens in hospitalized patients. Implementing universal screening with validated screening tools, clinical assessments, and standardized treatment protocols is associated with improved clinical care in hospitalized patients at risk for AWS

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