Table 1.

Benzodiazepine Dosing Strategies and National Prevalence of Each Strategy Among 6938 Medical Inpatients With Alcohol Withdrawal Syndrome in the Veterans Health Administration During 2013^a,b

Benzodiazepine dosing strategies		National prevalence in medical inpatients with AWS, No. (%; 95% CI)
Clinical definition	Operational definition for this study
Fixed-dose therapy A predetermined dose is administered at fixed, scheduled intervals Dose frequency/amount is tapered over a period of days	≥2 Doses of the same benzodiazepine administered on a scheduled basis at ≥4-h intervals (eg, every 6-8 h)	2829 (40.8; 35.5-46.3)
Symptom-triggered therapy Patients are monitored using a structured assessment scale (eg, CIWA-Ar) Medications are administered when symptoms cross a given severity threshold (eg, CIWA-Ar ≥8) Different doses of medication are administered for different categories of scores (eg, CIWA-Ar scores 8-15 vs >15)	≥2 Doses of the same benzodiazepine administered “PRN” (as needed) at ≥4-h intervals (eg, every 6-8 h)	2909 (41.9; 36.4-47.6)
Front-loading therapy Moderate to high doses of medication are administered frequently or continuously early in the course of treatment for rapid control of symptoms	(1) ≥40-mg diazepam equivalents of benzodiazepine administered as a 1-time dose AND/OR (2) Combination of “PRN” (as needed) and scheduled doses resulting in ≥40-mg diazepam equivalents of benzodiazepine within 4 h AND/OR (3) Any continuous infusion of benzodiazepine	1200 (17.3; 15.3-19.5)

^aAWS, alcohol withdrawal syndrome; CIWA-Ar, Clinical Institute Withdrawal Assessment for Alcohol revised.

^bEstimated confidence intervals account for intraclass correlations at the hospital level.