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    Prediction of Alcohol Withdrawal Severity Scale

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

    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
    Pearls/Pitfalls
    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
    No
    Yes

    Result:

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    Evidence
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    Management

    • Subjects at risk for alcohol withdrawal should be placed on symptom-triggered therapy.

    • May be used to inform which patients may be appropriate candidates for the CIWA-Ar protocol.

    Critical Actions

    PAWSS Scores ≥4 suggest high risk for complicated AWS. Prophylaxis and/or treatment may be indicated.

    Content Contributors
    About the Creator
    Dr. Jose R. Maldonado
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