Handelsman et al reported 2 rating scales for a patient undergoing opiate withdrawal, one subjective and the other objective. The authors are from the VA Medical Center in the Bronx.
Patient selection: opiate withdrawal
Clinical signs observed over 5 minutes:
(1) yawning
(2) rhinorrhea
(3) piloerection
(4) lacrimation
(5) tremor of hands
(6) mydriasis
(7) hot and cold flushing (shiver and/or huddling for warmth)
(8) restlessness
(9) vomiting
(10) muscle twitching
(11) abdominal cramps
(12) anxiety
(13) perspiration
|
Parameter |
Finding |
Points |
|
yawning |
none |
0 |
|
|
any |
1 |
|
rhinorrhea |
< 3 sniffs |
0 |
|
|
>= 3 sniffs |
1 |
|
piloerection |
absent |
0 |
|
|
present |
1 |
|
lacrimation |
absent |
0 |
|
|
present |
1 |
|
tremor of hands |
absent |
0 |
|
|
present |
1 |
|
mydriasis |
< 3 mm (absent) |
0 |
|
|
>= 3 mm (present) |
1 |
|
hot and cold flushing |
absent |
0 |
|
|
present |
1 |
|
restlessness |
absent |
0 |
|
|
frequent shifts of position |
1 |
|
vomiting |
absent |
0 |
|
|
present |
1 |
|
muscle twitching |
absent |
0 |
|
|
present |
1 |
|
abdominal cramps |
absent |
0 |
|
|
present (holding stomach) |
1 |
|
anxiety |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
1 |
|
|
severe |
1 |
|
perspiration |
absent |
0 |
|
|
present |
1 |
total score =
= SUM(points for all 13 clinical signs)
An alternative form:
(1) removes perspiration
(2) scores anxiety as absent (0), mild (1), moderate (2) or severe (3).
Interpretation:
• minimum score: 0
• maximum score: 13
• maximum alternative form: 14
• The higher the score the more extreme the objective symptoms of opiate withdrawal.
Purpose: To evaluate a patient for clinical signs of opiate withdrawal.
Specialty: Toxicology, Emergency Medicine, Critical Care
Objective: severity, prognosis, stage
ICD-10: F11,
