Risk assessment scale to predict severe alcohol withdrawal
Criteria
Part A: Threshold criteria
Have you consumed any amount of alcohol (i.e. been drinking) within the last 30 days?
Did the patient have a positive blood alcohol level on admission?
If the answer to either is YES then proceed to the next questions
Part B: Patient criteria (1 point each)
Have you been recently intoxicated or drunk within the last 30 days?
Have you ever undergone alcohol use disorder rehabilitation treatment or treatment for alcoholism? (i.e. inpatient or outpatient treatment programs or AA attendance)
Have you ever experienced any previous episodes of alcohol withdrawal, regardless of severity?
Have you ever experienced blackouts?
Have you ever experienced alcohol withdrawal seizures?
Have you ever experienced delirium tremens or DTs?
Have you combined alcohol with other "downers" like benzodiazepines or barbiturates, during the last 90 days?
Have you combined alcohol with any other substances of abuse, during the last 90 days?
Part C: Clinical evidence (1 point each)
Was the patient's blood alcohol level greater than 43.5 mmol/L? OR
For men, have you consumed more than 3 standard drinks in the past 12 hours?
For women, have you consumed more than 2 standard drinks in the past 12 hours?
Is there any evidence of increased autonomic activity? e.g. heart rate over 120 bpm, tremor, agitation, sweating, nausea
Interpretation
A score of 3 or lower suggests low risk, and outpatient management is suitable
A score of 4 or higher suggests high risk for severe/complicated alcohol withdrawal, and prophylaxis or inpatient treatment are indicated
