Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome

Abstract: Introduction and aim: The available literature and protocols have unequivocally suggested that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a psychometric scale for identifying and following the signs of alcohol withdrawal. However, there has not been any validated tool for the identification of withdrawal symptoms in Hungarian general hospital settings. The aim of the present study was to evaluate the validity and the reliability of the Hungarian version of this scale among patients hospitalized with alcohol withdrawal syndrome. Method: The translation of the scale into Hungarian was done by ‘back translation’ method, followed by testing the face validity. The empirical phase was performed in the Department of Psychiatry, University of Szeged. Patients admitted with alcohol withdrawal syndrome (n = 30) were recruited from the inpatient units of the clinic. Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression – Severity Scale were recorded every two days. Statistical comparisons of data were performed with repeated-measures ANOVA. Cronbach’s alpha, item-total correlation, convergent and discriminant validity were determined. Results: Significant decrease of the total scores of Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression – Severity Scale was observed between the six measurements (F = 202.46, p<0.001; F = 503.04, p<0.001). Cronbach alpha values were above 0.7 during the first 3 measurement days. The withdrawal and severity scores recorded the same day showed positively significant correlations (>0.45). Conclusion: Our findings demonstrate that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a reliable and valid psychometric tool for the detailed analysis of withdrawal symptoms in Hungarian general hospital settings. Orv Hetil. 2019; 160(30): 1184–1192.

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The “Prediction of Alcohol Withdrawal Severity Scale” (PAWSS): Systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome

Alcohol ◽

10.1016/j.alcohol.2014.01.004 ◽

2014 ◽

Vol 48 (4) ◽

pp. 375-390 ◽

Cited By ~ 46

Author(s):

José R. Maldonado ◽

Yelizaveta Sher ◽

Judith F. Ashouri ◽

Kelsey Hills-Evans ◽

Heavenly Swendsen ◽

...

Keyword(s):

Pilot Study ◽

Literature Review ◽

Systematic Literature Review ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Severity Scale

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Treatment of the Acute Alcohol-Withdrawal Syndrome

Quarterly Journal of Studies on Alcohol ◽

10.15288/qjsa.1958.19.118 ◽

1958 ◽

Vol 19 (1) ◽

pp. 118-124 ◽

Cited By ~ 4

Author(s):

Lincoln Godfrey ◽

Martin D. Kissen ◽

Thomas M. Downs

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome

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Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol – Revised: A systematic review-based meta-analysis

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.108536 ◽

2021 ◽

Vol 220 ◽

pp. 108536 ◽

Cited By ~ 1

Author(s):

Ildikó Katalin Pribék ◽

Ildikó Kovács ◽

Bettina Kata Kádár ◽

Csenge Sára Kovács ◽

Mara J. Richman ◽

...

Keyword(s):

Systematic Review ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Meta Analysis ◽

Alcohol Withdrawal Syndrome

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Implementation of the Modified Minnesota Detoxification Scale (mMINDS) for Alcohol Withdrawal Syndrome in Critically Ill Patients

The Joint Commission Journal on Quality and Patient Safety ◽

10.1016/j.jcjq.2020.08.006 ◽

2020 ◽

Vol 46 (11) ◽

pp. 656-658

Author(s):

Rachel M. Smith ◽

Brian Benzio ◽

Andrew L. Hendrickson ◽

Evan D. Telford ◽

Andrew J. Franck

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome

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Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00226-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tessa L. Steel ◽

Shewit P. Giovanni ◽

Sarah C. Katsandres ◽

Shawn M. Cohen ◽

Kevin B. Stephenson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Patient Characteristics ◽

Response To Treatment ◽

Alternative Measure ◽

Icu Patients ◽

Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

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