Interpretation
| Result | Meaning |
|---|---|
| Threshold not met | Not applicable / low risk |
| 0–3 | Low risk of complicated AWS |
| ≥ 4 | High risk of complicated AWS |
Formula
Threshold: any alcohol in last 30 days or positive BAL on admission (if no, stop). Then 1 point each: intoxicated in last 30 days; prior AUD rehab/treatment; prior withdrawal; prior blackouts; prior withdrawal seizures; prior DTs; alcohol + benzodiazepines/barbiturates in last 90 days; alcohol + other substance in last 90 days; BAL >200 mg/dL on presentation; increased autonomic activity (HR >120, tremor, sweating, agitation, nausea). Range 0–10.
Clinical pearls
- Validated in medically ill hospitalised patients, not in the ED or outpatients; it predicts risk, it does not grade current withdrawal (use CIWA-Ar for that).
- Score as soon as possible after admission; the blood alcohol item uses the level on presentation (200 mg/dL ≈ 43 mmol/L).
- Patients who cannot answer (intubated, delirious) can be scored from collateral history and records.
Examples
pawss drinks daily, prior withdrawal seizures, prior dts, blackouts, bal 250PAWSS: drank last week, intoxicated last month, prior rehab, no other risk factorsalcohol withdrawal risk for patient with prior withdrawal, benzos, tremor and HR 125
FAQ
What PAWSS score is high risk?
A PAWSS of 4 or more indicates high risk of complicated alcohol withdrawal (seizures or delirium tremens).
What is the difference between PAWSS and CIWA-Ar?
PAWSS predicts who is at risk of severe withdrawal before it happens; CIWA-Ar measures the severity of withdrawal that is already occurring to guide symptom-triggered treatment.