It is with great interest that we read the article by Tidwell et al1  on the use of phenobarbital for the treatment of alcohol withdrawal syndrome in comparison with the symptom-based protocol using lorazepam and the revised Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) scale. However, we believe that several issues that were not discussed must be highlighted because they affect the interpretation of the results.

Even though the retrospective design of the study limits the information obtained, the patients’ characteristics, reported in Table 2, are insufficiently detailed and prevent adequate comparison.1  Indeed, the severity of the alcohol withdrawal syndrome is not reported, nor are the diagnoses or comorbid conditions justifying patients’ admission to the intensive care unit and any complications that occurred during their stay. Diagnosis, comorbid conditions, and complications can influence patients’ vital signs, making the CIWA-Ar scale more difficult to interpret, possibly favoring the phenobarbital...

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