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Hey #medtwitter #psychtwitter #PharmICU - I know phenobarbital for alcohol withdrawal is cool again, but at @HopkinsMedicine we've been working on some things with boring old benzos that I want to put on your radar:
You know that symptom-triggered alcohol withdrawal management reduces benzo use + treatment time compared to fixed-dose strategies. CIWA-Ar is most commonly used, but can be time-consuming to perform.
Our team, led by Darius Rastegar, has developed and evaluated the shorter Brief Alcohol Withdrawal Scale (BAWS) to simplify assessment and treatment of alcohol withdrawal.
This first study compared BAWS with CIWA-Ar for validation in an inpatient substance withdrawal unit. @SubstanceAbuseJ https://pubmed.ncbi.nlm.nih.gov/28699845/
This next study evaluated 799 inpatients (med + surg, non-ICU + ICU) who were managed with BAWS to confirm its effectiveness in a broader population of hospitalized patients. Shout out to @brian_lindner1 for doing the hard work. @JAM_ASAM https://journals.lww.com/journaladdictionmedicine/Abstract/2019/10000/Evaluation_of_the_Brief_Alcohol_Withdrawal_Scale.8.aspx
And this study just published today evaluated BAWS specifically in a small population of ICU patients with severe withdrawal. https://journals.sagepub.com/eprint/QSUVXJDFHKRSKGPYJYWC/full#articleShareContainer
One last thing: many who screen positive for alcohol withdrawal risk do not go on to experience alcohol withdrawal. I find this is particularly common in surgery/trauma. BAWS avoids unnecessarily treating those not in withdrawal, which is key to the symptom-triggered approach.
