We read with interest the recent work by Tidwell et al1  regarding the treatment of alcohol withdrawal. While this topic is of great interest, we believe that several methodological shortcomings limit the applicability of the results.

The description of the inclusion criteria is insufficient. Specifically, it is unclear whether consecutive patients were included or whether patients were selected from a larger cohort because of characteristics that were not described. The high rate of intubation in the group evaluated with the revised Clinical Institute Withdrawal Assessment of Alcohol scale (CIWA-Ar) is striking, raising the concern that patients with poor outcomes were disproportionally included in the CIWA-Ar group. Clinical interpretation of the article could be improved if the authors included vital signs and more demographic information to define the patient population more clearly.

Additionally, the 2 groups are not matched. The CIWA-Ar group is significantly older (52 vs 45 years) and...

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