Prediction of Alcohol Withdrawal Severity Scale

Aka: Prediction of Alcohol Withdrawal Severity Scale, PAWSS Scale

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II. Indications

  1. Alcohol Withdrawal Syndrome in age 18 years and older
    1. Assess risk of complicated Alcohol Withdrawal in patients admitted to general medical floor

III. Contraindications

  1. Active or uncontrolled Seizure Disorder
  2. Non-english speaking patients

IV. Criteria (assign 1 point per positive answer)

  1. Intoxicated within the last 30 days?
  2. Prior treatment for Alcohol Use Disorder (includes AA, rehabilitation program)
  3. Prior Alcohol Withdrawal symptoms?
  4. Prior blackouts?
  5. Prior Alcohol WithdrawalSeizures?
  6. Prior Delirium Tremens?
  7. In the past 90 days, have you combined Alcohol with other "downers" (e.g. Benzodiazepines, Barbiturates)?
  8. Blood Alcohol Level >200 mg/dl on this presentation?
  9. Autonomic hyperactivity at time of evaluation (Tachycardia, Tremor, diaphoresis, Agitation, Nausea)?

V. Interpretation

  1. Score >=4 predicts a high risk of complicated Alcohol Withdrawal (LR+ 174, in contrast with LR+ 0.07)

VI. References

  1. Maldonado (2014) Alcohol 48(4):375-90 +PMID: 24657098 [PubMed]
  2. Maldonado (2015) Alcohol Alcohol 50(5):509-18 +PMID: 25999438 [PubMed]

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