title: Evaluation of a symptom-triggered protocol approach to the management of alcohol withdrawal syndrome in older adults.
abstract: OBJECTIVE
  To evaluate whether implementation of symptom-triggered administration of a benzodiazepine protocol reduces the severity (total cumulative dose), duration, and complications of alcohol withdrawal syndrome (AWS).
  
  
  METHODS
  Retrospective health record review.
  
  
  METHODS
  Tertiary care center in Vancouver, Canada.
  
  
  METHODS
  Individuals aged 70 and older admitted to the Acute Care for Elders and Acute Medicine Unit wards with diagnostic codes for AWS from 2008 to 2012.
  
  
  METHODS
  Median duration and cumulative dose of benzodiazepine treatment, number of severe AWS complications, severe benzodiazepine-associated adverse effects, and need for adjunct therapy.
  
  
  RESULTS
  Thirty-three participants in the preprotocol group and 30 in the protocol-implemented group met the inclusion criteria. Median duration of benzodiazepine treatment decreased from 96 hours (interquartile range (IQR) 72-120 hours) in the preprotocol period to 48 hours (IQR 0-108 hours; P=.04), and median cumulative benzodiazepine dose administered decreased from 9 mg (IQR 5-19.8 mg) to 3 mg (IQR 0-10 mg; P=.001). Statistically significantly lower incidence of severe AWS complications (P=.007) and adjunct therapy use (P=.02) was seen in the protocol-implemented group.
  
  
  CONCLUSIONS
  A symptom-triggered protocol for dosing of benzodiazepine therapy in the management of AWS in individuals aged 70 and older significantly reduced the total duration of benzodiazepine use, cumulative benzodiazepine dose, and use of adjunctive medications in the treatment of AWS.
authors: Pharmaceutical Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Asal
authors: A
authors: Taheri
authors: Karen
authors: K
authors: Dahri
authors: Peter
authors: P
authors: Chan
authors: Maureen
authors: M
authors: Shaw
authors: Amneet
authors: A
authors: Aulakh
authors: Amir
authors: A
authors: Tashakkor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications*; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects; D001955:British Columbia; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D001569:Benzodiazepines; D000431:Ethanol
keywords: alcohol; benzodiazepines; confusion; delirium; delirium tremens; geriatrics; screening; senior or older adult; symptom-triggered; treatment; withdrawal