{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:07:37Z","timestamp":1791220057322,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R38HL143581"],"award-info":[{"award-number":["R38HL143581"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Despite frequent treatment of alcohol withdrawal syndrome (AWS) in the emergency department (ED), evidence for phenobarbital (PB) as an ED alternative therapy is mixed. We conducted a systematic review and meta\u2010analysis comparing safety and efficacy of PB to benzodiazepines (BZDs) for treatment of AWS in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched articles and references published in English in PubMed, Web of Science, and Embase from inception through May 2022. We included randomized trials and cohort studies comparing treatment with PB to BZD controls and excluded studies focused on non\u2010AWS conditions. Review was conducted by two blinded investigators and a third author; eight of 59 (13.6%) abstracts met inclusion criteria for review and meta\u2010analysis using a random\u2010effects model. Treatment superiority was evaluated through utilization, pharmacologic, and clinical outcomes. Primary outcomes for meta\u2010analysis were the proportion of patients (1) admitted to the intensive care unit (ICU), (2) admitted to the hospital, (3) readmitted to the ED after discharge, and (4) who experienced adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight studies (two randomized controlled trials, six retrospective cohorts) comprised data from 1507 patients in 2012 treatment encounters for AWS. All studies were included in meta\u2010analysis for adverse events, seven for hospital admission, five for ICU admission, and three for readmission to the ED after discharge. Overall methodological quality was low\u2010moderate, risk of bias moderate\u2010high, and statistical heterogeneity moderate. Pooled relative risk of ICU admission for those treated with PB versus BZD was 0.92 (95% confidence interval [CI] 0.54\u20131.55). Risk for admission to the hospital was 0.98 (95% CI 0.89\u20131.07) and for any adverse event was 1.1 (95% CI 0.78\u20131.57); heterogeneity prevented meta\u2010analysis for ED readmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The current literature base does not show that treatment with PB significantly reduces ICU admissions, hospital admissions, ED readmissions, or adverse events in ED patients with AWS compared with BZDs alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.14825","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T20:58:05Z","timestamp":1699045085000},"page":"515-524","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Phenobarbital treatment of alcohol withdrawal in the emergency department: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5502-2552","authenticated-orcid":false,"given":"Carmen M.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Highland Hospital, Alameda Health System  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0729-0162","authenticated-orcid":false,"given":"David G.","family":"Dillon","sequence":"additional","affiliation":[{"name":"University of California Davis School of Medicine  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy M.","family":"Tahir","sequence":"additional","affiliation":[{"name":"University of California San Francisco Library  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4274-0176","authenticated-orcid":false,"suffix":"IV","given":"Charles E.","family":"Murphy","sequence":"additional","affiliation":[{"name":"University of California San Francisco School of Medicine  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.13559"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agw074"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/OAEM.S235288"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.22942"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.4308"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15589"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0422"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCN.0000578828.37034.c2"},{"key":"e_1_2_7_10_1","first-page":"53","article-title":"Management of Alcohol Withdrawal in the emergency department: current perspectives. Open access","volume":"12","author":"Wolf C","year":"2020","journal-title":"Emerg Med"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2018745"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alcohol.2019.07.004"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-021-00524-1"},{"key":"e_1_2_7_14_1","unstructured":"MosesS.Benzodiazepine equivalents. Family Practice Notebook LLC. 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