ToolsCalculators
Prediction of Alcohol Withdrawal Severity Scale (PAWSS)
Identifies patients at risk of complicated (moderate-to-severe) alcohol withdrawal.
Prediction of Alcohol Withdrawal Severity Scale (PAWSS)
Intoxicated within the last 30 days
Previous episode of alcohol withdrawal
Previous alcohol withdrawal seizure
Previous delirium tremens (DTs)
Previous alcohol rehabilitation treatment
Previous alcohol-related blackouts
Combined alcohol with benzodiazepines or barbiturates
Combined alcohol with other substances of abuse
Blood alcohol level >200 mg/dL on presentation
Evidence of autonomic hyperactivity (HR >120, tremor, sweating, agitation, nausea)
Result0 points
Score <4: low risk of complicated alcohol withdrawal.
- Threshold for high risk
- >= 4 points
When to use
- Risk-stratifying inpatients for complicated alcohol withdrawal to guide prophylaxis and monitoring.
Formula
One point for each of 10 items (recent intoxication; prior withdrawal, seizures, DTs, rehab, blackouts; combined depressant or other substance use; BAL >200 mg/dL; autonomic hyperactivity). Range 0-10; >=4 indicates high risk. A threshold criterion (any alcohol in prior 30 days or a positive BAL) gates use of the scale.
Pearls and pitfalls
- Apply only when the threshold criterion is met (recent drinking or a positive blood alcohol level).
- A score >=4 has high sensitivity and specificity for severe withdrawal in the validation cohort.