Link To And Excerpts From “Prediction of Alcohol Withdrawl Severity Scale” On MDCalc

In this post I link to and excerpt from a tool used for the  recognition of alcohol withdrawl, the Prediction of Alcohol Withdrawal Severity Scale* by Joseph Maldano MD available from  MDCalc.

*This link is to the MDCalc resource on the above. And here are some excerpts from the MDCalc page.

Prediction of Alcohol Withdrawal Severity Scale:

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


When To 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.

Why Use?

  • 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).

Now go to the MDCalc page, Prediction of Alcohol Withdrawal Severity Scale,  to determine the patient’s PAWSS score.

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