Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review
Dublin Core
Title
Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review
Subject
Alcohol, Substance use, Emergency department, Drug therapy
Description
Background: Patients who experience harms from alcohol and other substance use often seek care in the emergency
department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19
pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must
reliably identify those who are safe for outpatient management versus those who require more intensive levels of care.
Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not
provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the
treatment of alcohol withdrawal syndrome in the ED.
Methods: We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of
Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference
abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We
included interventional and observational studies that reported outcomes of clinical interventions aimed at
treating alcohol withdrawal syndrome in adults in the ED.
Results: We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6
observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and
summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other
alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is
unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to
determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol
withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED.
department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19
pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must
reliably identify those who are safe for outpatient management versus those who require more intensive levels of care.
Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not
provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the
treatment of alcohol withdrawal syndrome in the ED.
Methods: We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of
Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference
abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We
included interventional and observational studies that reported outcomes of clinical interventions aimed at
treating alcohol withdrawal syndrome in adults in the ED.
Results: We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6
observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and
summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other
alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is
unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to
determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol
withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED.
Creator
Justin Jek-Kahn Koh , Madeline Malczewska, Mary M. Doyle-Waters and Jessica Moe
Publisher
BMC Emergency Medicine
Date
(2021) 21:131
Contributor
Fajar bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Justin Jek-Kahn Koh , Madeline Malczewska, Mary M. Doyle-Waters and Jessica Moe, “Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review,” Repository Horizon University Indonesia, accessed September 20, 2024, https://repository.horizon.ac.id/items/show/3912.