Wetterling et al developed the Alcohol Withdrawal Scale (AWS) to evaluate a patient undergoing alcohol withdrawal. This can help to quantitate the severity of the withdrawal syndrome and guide management. The authors are from the University Medical School of Lubeck and Psychiatric Hospital Heiligenhafen in Germany.
Subscales:
(1) somatic symptoms (S)
(2) mental symptoms (M)
Parameters for somatic symptoms:
(1) pulse rate in beats per minute
(2) diastolic blood pressure in mm Hg
(3) body temperature in °C
(4) breathing rate in breaths per minute
(5) sweating
(6) tremor
Parameters for mental symptoms:
(1) agitation
(2) contact
(3) orientation (time, person, place, situation)
(4) hallucinations (optical, acoustic, tactile)
(5) anxiety
|
Parameter |
Finding |
Points |
|
pulse |
< 100 |
0 |
|
|
101 to 110 |
1 |
|
|
111 to 120 |
2 |
|
|
> 120 |
3 |
|
diastolic blood pressure |
< 95 |
0 |
|
|
95 to 100 |
1 |
|
|
101 to 105 |
2 |
|
|
> 105 |
3 |
|
body temperature |
< 37.0°C |
0 |
|
|
37.0 to 37.5 |
1 |
|
|
37.6 to 38.0 |
2 |
|
|
> 38.0 |
3 |
|
breathing rate |
< 20 |
0 |
|
|
20 to 24 |
1 |
|
|
> 24 |
2 |
|
sweating |
none |
0 |
|
|
mild (palms) |
1 |
|
|
moderate (forehead) |
2 |
|
|
severe (profuse) |
3 |
|
tremor |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
subscore for somatic symptoms =
= SUM(points for all 6 parameters)
|
Parameters |
Findings |
Points |
|
agitation |
none |
0 |
|
|
fastening |
1 |
|
|
rolling in the bed |
2 |
|
|
trying to leave the bed |
3 |
|
|
in a rage |
4 |
|
contact |
short talk possible |
0 |
|
|
easily distracted |
1 |
|
|
drifting contact |
2 |
|
|
dialogue impossible |
3 |
|
orientation |
oriented to all 4 |
0 |
|
|
disoriented to 1 |
1 |
|
|
disoriented to 2 |
2 |
|
|
totally confused |
3 |
|
hallucinations |
none |
0 |
|
|
suggestive |
1 |
|
|
one kind |
2 |
|
|
two kinds |
3 |
|
|
all three kinds |
4 |
|
anxiety |
none |
0 |
|
|
mild |
1 |
|
|
severe |
2 |
subscore for mental symptoms =
= SUM(points for all 5 parameters)
total score =
= (points for somatic symptoms) + (points for mental symptoms)
Interpretation:
• minimum somatic, mental and total score: 0
• maximum subscore for somatic symptoms: 17
• maximum subscore for mental symptoms: 16
• maximum subscore for total symptoms: 33
• The higher the score the greater the severity of the withdrawal.
|
Total Score |
Withdrawal Severity |
|
0 to 5 |
mild |
|
6 to 9 |
moderate |
|
10 to 33 |
severe |
Specialty: Toxicology, Emergency Medicine, Critical Care
