Prediction of alcohol withdrawal severity scale

• 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