(915) Use of Phenobarbital in Discharged Emergency Department Patients With Non-Severe Alcohol Withdrawal

Introduction: The safety and efficacy of administering parenteral phenobarbital to patients discharged from the emergency department (ED) for alcohol withdrawal is not well established and studies to date have primarily evaluated the intravenous (IV) route of administration. The purpose of this study was to validate this practice and determine the role of intramuscular (IM) phenobarbital for this indication.

Methods: This was a single center, retrospective chart review of adults who were discharged following the administration of parenteral phenobarbital from the ED within 12 hours of presentation with non-severe alcohol withdrawal symptoms. The primary safety and efficacy endpoints were the percentages of patients who expired or re-presented to the ED for an alcohol-related diagnosis within seven days of the initial presentation, respectively. Patients were excluded if they were transferred to another facility, received a benzodiazepine during their ED visit, or were prescribed a barbiturate or benzodiazepine on discharge. A subgroup analysis was performed to compare outcomes between those who only received IM or IV phenobarbital.

Results: 192 patient encounters were included. The median (interquartile range) dose received in the total population was 260 mg (130-260). The percentages of patients who solely received IV or IM phenobarbital were 54.1% and 39.1%, respectively. No deaths were reported in the cohort. Twenty-one (10.9%) patients re-presented subsequent to the initial visit, received treatment, and were discharged home. One (0.52%) patient was admitted following re-presentation. Within the IM and IV only phenobarbital groups, the total and weight-based doses received were not significantly different between those who did and did not re-present. The percentages of patients who re-presented after exclusively receiving IM or IV phenobarbital were 8% and 13.5%, respectively (p = 0.25). The median ED length of stay in those who solely received IM or IV phenobarbital was 3.97h and 5.87h, respectively (p < 0.001).

Conclusions: Our findings suggest patients can be safely discharged home after receiving IM or IV phenobarbital once there is symptom control, without the need for additional outpatient alcohol withdrawal medication prescriptions.