Methodology: 4/5
Usefulness: 2/5
Lee CM, et al. Acad Emerg Med. 2024 May;31(5):515-524.
Question and Methods: This is a systematic review and meta-analysis comparing the safety and efficacy of phenobarbital to benzodiazepines for the treatment of alcohol withdrawal in the emergency department.
Findings: Overall, eight studies comprising 1,507 patients were included and there was no statistically significant difference in ICU admissions, hospital admissions or adverse events, for patients treated with phenobarbital versus benzodiazepines.
Limitations: Major limitations to this study include low-moderate quality of original studies with moderate-high risk of bias, as well as significant heterogeneity in reported data.
Interpretation: While phenobarbital will not be replacing benzodiazepines as first-line treatment for alcohol withdrawal, these results are reassuring from a safety perspective, without significant changes in hospital/ICU admission rates, which will make one more inclined to use phenobarbital for refractory alcohol withdrawal cases.
JC Supervisor: Dr. Ian Stiell
