Phenobarbital Treatment of Alcohol Withdrawal in the Emergency Department: A Systematic Review and Meta-analysis
Authors: Carmen M Lee, David G Dillon, Peggy M Tahir, Charles E Murphy
Published in: Academic Emergency Medicine, 2023 November 4
Conclusions:
- The evidence does not support phenobarbital significantly reducing ICU admissions, hospital admissions, ED readmissions, or adverse events for patients with AWS in the ED when compared with benzodiazepines.
Methods:
- Systematic review and meta-analysis of articles in English from PubMed, Web of Science, and Embase up to May 2022.
- Included randomized trials and cohort studies comparing phenobarbital to benzodiazepines for AWS treatment.
- Excluded studies that did not focus on AWS.
- Two blinded investigators and a third author reviewed studies; 8 of 59 abstracts met criteria for inclusion.
- Meta-analysis using a random-effects model, focusing on ICU admission, hospital admission, ED readmission, and adverse events.
Results:
- Eight studies (2 randomized controlled trials and 6 retrospective cohorts) were included, representing 1,507 patients and 2,012 treatment encounters.
- The studies contributed to the meta-analysis for adverse events, hospital admission, ICU admission, and ED readmission post-discharge.
- Overall methodological quality was low to moderate, with a moderate to high risk of bias and moderate statistical heterogeneity.
- Pooled relative risks were:
- ICU admission: 0.92 (95% CI 0.54-1.55)
- Hospital admission: 0.98 (95% CI 0.89-1.07)
- Adverse events: 1.1 (95% CI 0.78-1.57)
- Meta-analysis for ED readmission was not possible due to heterogeneity.