Transition From CIWA-Ar to a Brief Alcohol Withdrawal Scale-based Protocol in General Medical Inpatients: An Interrupted Time Series Analysis

OBJECTIVES: The Brief Alcohol Withdrawal Scale (BAWS) is a shorter alternative to the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar), but the two have not been compared in general medical inpatients. We evaluated a transition from CIWA-Ar to BAWS in this population. METHODS: Interrupted time series study of adults admitted from the emergency department to internal medicine with alcohol withdrawal syndrome, April 2021-April 2023. In April 2022, CIWA-Ar was replaced by BAWS, bundled with risk stratification and a phenobarbital pathway requiring intensive care unit (ICU) admission for intravenous dosing. Primary outcomes (total sedative exposure in lorazepam equivalents, length of stay, inflation-adjusted cost) were analyzed as weekly series with segmented regression; secondary outcomes were ICU transfer, 30-day readmission, in-hospital mortality, and discharge against medical advice. RESULTS: Of 23,506 encounters, 1341 were eligible. The transition produced no immediate (level) or sustained (slope) change in total sedative exposure (level -2.9 mg, 95% CI: -8.4 to 2.6), length of stay (-0.40 d, 95% CI: -1.5 to 0.69), or cost (0.027, 95% CI: -0.040 to 0.096), and was not associated with ICU transfer (OR 1.61, 95% CI: 0.83-3.19), 30-day readmission (OR 1.16, 0.87-1.54), in-hospital mortality (OR 1.32, 0.32-5.88), or discharge against medical advice (OR 0.90, 0.58-1.37); unadjusted phenobarbital use and ICU transfer increased. CONCLUSIONS: Replacing CIWA-Ar with BAWS did not change total sedative exposure, length of stay, cost, or clinical outcomes in general medical inpatients. BAWS can be adopted safely, although the ICU requirement for intravenous phenobarbital may have offset potential resource gains.