Improving Identification of Admitted Patients at High Risk for Complicated Alcohol Withdrawal Using the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) Tool

Background: Alcohol use disorder (AUD) has among been reported in 10-32% of hospitalized patients. The evidence suggests the need for screening and early management of alcohol withdrawal syndrome (AWS). Methods: This project included 2 phases - retrospective and prospective chart reviews. Demographic variables (age, gender, race) and length of stay were examined. Statistical tests were conducted to compare data from the phases. The outcome variables examined were the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale. Results: Of 61 patients in phase 1, most (72.5%) were males, had an average age of 47.1 years, and a length of stay of 8.1 days. Most (96.7%) of the patients were placed on CIWA at admission. In one patient, there was not a prompt initiation of the CIWA protocol and alcohol withdrawal treatment, which may have resulted in a reduced incidence of delirium and a shorter hospital stay. Of the 16 patients in phase 2, most (81.3%) were males, Caucasians (62.5%), with an average age of 49.3 years and a mean length of stay of 5.5 days. There were no significant differences at p<.05 between characteristics in the two phases of the study. In phase 2, 7 of 16 patients (43.8%) had a PAWSS score >=4, indicating that these patients were at high risk. 5 of these 7 patients experienced severe withdrawal symptoms making this a true positive PAWSS score. The PAWSS scores were not recorded for 9 patients in this study phase, and 7 of these patients had CIWA score >=16, indicating that the patients may experience severe withdrawal symptoms. Conclusion: As the problem of AUD continues to exist, more detailed information about the use of PAWSS and CIWA to assess alcohol withdrawal is needed. Improving strategies to evaluate the effect CIWA management may be warranted.