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    Chief Complaint


    Organ System


    Patent Pending

    Prediction of Alcohol Withdrawal Severity Scale

    Screens hospitalized patients for complicated alcohol withdrawal (seizures, delirium tremens).


    Use in patients ≥18 years old admitted to general floor, with or without history of alcohol abuse. Do not use in patients with active or uncontrolled seizure disorder.

    When to Use
    Why Use

    • Patients ≥18 years old admitted to general floor, with or without history of alcohol abuse.

    • Do not use in patients with active or uncontrolled seizure disorder.

    • Complicated alcohol withdrawal syndrome (AWS) is defined as withdrawal hallucinosis, withdrawal-related seizures, or delirium tremens.

    • Not yet validated in non-English speaking patients.

    • Patients with active or uncontrolled seizure disorder, obtunded, or unable to understand the questionnaire were excluded from the study.

    • The majority of patients included in the studies were on general medical floors. A limited number of patients from the emergency department, surgical floors, and critical care units were included.

    • Other alcohol withdrawal tools like CIWA-Ar stratify severity of AWS and can be used sequentially with the PAWSS (i.e., use PAWSS to screen for those at high risk for AWS, then use CIWA-Ar to determine if treatment is needed) (Eloma 2018).

    • 10% of symptomatic individuals experience withdrawal-related generalized tonic-clonic seizures. If left untreated, about one-third of patients with withdrawal seizures will progress to delirium tremens.

    • Prevalence of at-risk or heavy alcohol use tends to be higher among adults actively seeking healthcare in the general population.

    • Most patients undergoing alcohol withdrawal experience uncomplicated AWS and only need supportive care, but up to 20% have complicated AWS (i.e., withdrawal hallucinosis, seizures, delirium tremens), which can result in substantial morbidity and up to 15% mortality if unrecognized. With aggressive prevention and recognition, mortality rates decrease to 1-4% (Schuckit 2014).

    • PAWSS Scores ≥4 were 93.1% sensitive and 99.5% specific for development of complicated AWS in prospective validation (Maldonado 2015).

    Threshold criteria


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    Creator Insights
    Dr. Jose R. Maldonado

    About the Creator

    Jose R. Maldonado, MD, FAPM, FACFE, is a professor of psychiatry and behavioral sciences at Stanford University Medical Center. He is also the medical director of psychosomatic medicine and chief of psychiatric emergency services and transplant psychiatry at Stanford University Medical Center. Dr. Maldonado’s research focuses primarily on solid organ transplantation, delirium, and neuropathophysiology of alcohol withdrawal syndrome.

    To view Dr. Jose R. Maldonado's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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    Dr. Jose R. Maldonado
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