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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Withdrawal Assessment Tool (WAT-1) for Pediatric Withdrawal

    Estimates severity of opioid and benzodiazepine withdrawal in children.
    When to Use
    Pearls/Pitfalls
    Why Use

    • Pediatric patients (age 2 weeks to 18 years in the original study) at risk for opioid withdrawal (i.e., on sedation for ≥5 days). 

    • Note that the population in this study was limited to those intubated for respiratory conditions, which, while common, may limit applicability to children intubated and sedated for other reasons (e.g. status epilepticus or head trauma).

    • Children on round-the-clock sedation for ≥5 days (e.g. when intubated and sedated in the PICU) are at higher risk for withdrawal than children sedated for ≤4 days. Additionally, administration of sedatives via continuous or intermittent dosing does not alter the likelihood of withdrawal.

    • May be used to trend improvement or worsening in withdrawal symptoms over time.

    • WAT-1 scores ≥3 were 87.2% sensitive and 88% specific for predicting severe withdrawal symptoms, and correlated with longer duration of intubation and opioid sedation, longer time needed to wean from all sedatives, and greater length of stay (both PICU stay and overall hospitalization).

    • Withdrawal symptoms in neonates and infants may be subtler than in older children, and may include jitteriness, irritability, or inconsolability.

    • Patients being weaned from continuous sedation using agents such as morphine, methadone, or lorazepam should be monitored closely for respiratory depression and oversedation.

    Up to 94% of PICUs experience issues with iatrogenic sedative withdrawal symptoms in their patients, which can prolong length of stay.

    Previous 12 hours
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    Observe 2 mins before stimulus (e.g. routine care)
    ≤0 OR asleep or awake and calm
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    ≥1 OR awake and distressed
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    0-1 time
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    Observe during 1 min progressive stimulus
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    Moderate to severe
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    Normal
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    Increased
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    Post-stimulus recovery
    <2 min
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    2-5 min
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    >5 min
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    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Linda S. Franck

    About the Creator

    Linda S. Franck, RN, PhD, FRCPCH, is a professor of family health care nursing at University of California, San Francisco (UCSF). She is also the co-principal investigator for the UCSF Preterm Birth Initiative. Dr. Franck’s primary research is focused on improving family-centered care.

    To view Dr. Linda S. Franck's publications, visit PubMed

    Are you Dr. Linda S. Franck? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    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.
    Content Contributors
    About the Creator
    Dr. Linda S. Franck
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