Franck et al reported the Withdrawal Assessment Tool (WAT-1) for evaluation of opioid or benzodiazepine withdrawal in a pediatric patient. The authors are from University College London, Great Ormond Street Hospital for Children, Children's Hospital Boston, Harvard University, Children's Hospital of Wisconsin, Children's Hospital National Medical Center and University of Pennsylvania.
Patient selection: pediatric patient with opioid or benzodiazepine withdrawal
Parameters:
(1) loose or watery stools
(2) vomiting, retching and/or gagging
(3) temperature in °C
(4) state (in 2 minutes prior to stimulus)
(5) tremor (in 2 minutes prior to stimulus)
(6) sweating (in 2 minutes prior to stimulus)
(7) uncoordinated or repetitive movements (in 2 minutes prior to stimulus)
(8) yawning or sneezing (in 2 minutes prior to stimulus)
(9) startle to touch (during 1 minute stimulus observation)
(10) muscle tone (during 1 minute stimulus observation)
(11) time to gain calm state after 1 minute stimulus
Parameter
|
Finding
|
Points
|
loose or watery stools
|
no
|
0
|
|
yes
|
1
|
vomiting, retching, gagging
|
no
|
0
|
|
yes
|
1
|
temperature
|
<= 37.8°C
|
0
|
|
> 37.8°C
|
1
|
state prior to stimulus
|
calm or asleep
|
0
|
|
distressed
|
1
|
tremor
|
none or mild
|
0
|
|
moderate or severe
|
1
|
any sweating
|
no
|
0
|
|
yes
|
1
|
uncoordinated movement
|
none or mild
|
0
|
|
moderate ot severe
|
1
|
yawning or sneezing
|
none or 1
|
0
|
|
>= 2
|
1
|
startle to touch
|
none or mild
|
0
|
|
moderate or severe
|
1
|
muscle tone
|
normal
|
0
|
|
increased
|
1
|
time to recover
|
< 2 minutes
|
0
|
|
2 to 5 minutes
|
1
|
|
> 5 minutes
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• A score >= 3 predicts a 10-point numeric rating scale >=4.
Performance:
• The area under the ROC curve is 0.944.