Crepeault Hannah, Cowan Nicole, Socias M Eugenia, Riazi Niloofar, Knill Alison, Khela Avneet, Wood Evan, Ti Lianping
British Columbia Centre on Substance Use, Vancouver, Canada.
Vancouver Detox Centre, Vancouver Coastal Health, Vancouver, Canada.
Drug Alcohol Rev. 2025 Jul;44(5):1365-1373. doi: 10.1111/dar.14075. Epub 2025 May 6.
Severe alcohol withdrawal syndrome (SAWS) can lead to significant morbidity and mortality. The Prediction of Alcohol Withdrawal Severity Scale (PAWSS) has been validated in general acute care environments, but its efficacy in withdrawal management settings remains underexplored. This study aimed to assess the utility of a modified PAWSS and identify appropriate cutoff scores in a community withdrawal management setting in Vancouver, Canada.
From October 2019 to September 2022, we reviewed charts at Vancouver Detox Centre. Modified PAWSS versions replaced question 9 on the original PAWSS with: (i) breath analysis readings; (ii) alcohol consumption in the previous 24 h; and (iii) clinical assessments. We performed receiver operating characteristic analysis and used Youden's index to determine modified PAWSS' diagnostic accuracy against SAWS presentation, defined by a score of 15 or greater on the Clinical Institute Withdrawal Assessment Alcohol, Revised, seizures or delirium tremens and/or benzodiazepine administration.
Among 228 individuals (165 male, 63 female), 175 (75%) met SAWS criteria during admission. For breath analysis readings, an optimal PAWSS cutoff score had 55% sensitivity (95% confidence interval [CI] 46%-63%) and 74% specificity (95% CI 54%-87%). For alcohol consumption in the last 24 h, a cutoff score of 7 had 44% sensitivity (95% CI 36%-51%) and 85% specificity (95% CI 70%-93%). For clinical assessment, a cutoff score of 6 had 53% sensitivity (95% CI 45%-61%) and 71% specificity (95% CI 58%-85%).
Within a community withdrawal setting, the prevalence of SAWS was high, rendering the modified PAWSS less valuable. Although higher cutoff scores improved specificity, poor sensitivity hindered identification of low-risk SAWS individuals.
严重酒精戒断综合征（SAWS）可导致显著的发病率和死亡率。酒精戒断严重程度预测量表（PAWSS）已在一般急性护理环境中得到验证，但其在戒断管理环境中的有效性仍未得到充分探索。本研究旨在评估改良版PAWSS的效用，并确定加拿大温哥华社区戒断管理环境中的适当临界值分数。
2019年10月至2022年9月，我们查阅了温哥华戒毒中心的病历。改良版PAWSS版本将原始PAWSS上的问题9替换为：（i）呼气分析读数；（ii）过去24小时内的酒精摄入量；以及（iii）临床评估。我们进行了受试者操作特征分析，并使用尤登指数来确定改良版PAWSS对SAWS表现的诊断准确性，SAWS表现由临床研究所酒精戒断评估修订版、癫痫发作或震颤谵妄和/或苯二氮䓬类药物给药评分为15分或更高来定义。
在228名个体（165名男性，63名女性）中，175名（75%）在入院期间符合SAWS标准。对于呼气分析读数，最佳PAWSS临界值分数的灵敏度为55%（95%置信区间[CI]46%-63%），特异度为74%（95%CI 54%-87%）。对于过去24小时内的酒精摄入量，临界值分数为7时，灵敏度为44%（95%CI 36%-51%），特异度为85%（95%CI 70%-93%）。对于临床评估，临界值分数为6时，灵敏度为53%（95%CI 45%-61%），特异度为71%（95%CI 58%-85%）。
在社区戒断环境中，SAWS的患病率很高，这使得改良版PAWSS的价值降低。虽然较高的临界值分数提高了特异度，但灵敏度不佳阻碍了对低风险SAWS个体的识别。
