To investigate the misdiagnosis causes and treatment strategies for burns combined with alcohol withdrawal syndrome (AWS). This study was a retrospective observational study. From January 2014 to December 2023, 334 male burn patients aged 29-90 (53±11) years and combined with alcohol dependence were admitted to the PLA Burn Center of the 990 Hospital of Joint Logistics Support Force. Patients were divided into AWS group (29 cases) and non-AWS group (305 cases) based on whether AWS developed or not. The misdiagnosis causes and treatment outcomes of AWS of patients in AWS group were analyzed. The total burn surface area, full-thickness burn area, burn index, hospitalization day, and mortality were compared between patients in the two groups. The 334 patients were further stratified by burn severity into mild-moderate burn patients (306 cases), severe burn patients (11 cases), and critically severe burn patients (17 cases), and the correlation between AWS incidence and burn severity in patients with burns combined with alcohol dependence was analyzed. The misdiagnosis causes of AWS in AWS group of patients were primarily insufficient clinician awareness of AWS (48.3%, 14/29) and then overlapping symptoms between AWS and burn-related complications, such as shock, electrolyte imbalance, stress-induced mental disorders, and epilepsy (51.7%, 15/29), which influenced judgement of the clinicians. After active treatment, the AWS symptoms alleviated obviously or disappeared in 27 patients, while 2 patients died of multiple organ failure. Compared with those in non-AWS group, the total burn surface area, full-thickness burn area, burn index, and hospitalization day of patients in AWS group were significantly increased (with values of -8.35, -6.98, -8.32, and -4.56, respectively, <0.05). The mortality of patients in AWS group was 6.9% (2/29), which was significantly higher than 0.7% (2/305) in non-AWS group (<0.05). The AWS incidences of patients with mild-moderate burn, severe burn, and critically severe burn were 4/306, 8/11, and 17/17, respectively, and the AWS incidences of burn patients combined with alcohol dependence had strongly positive correlation with burn severity (=0.87, <0.05). The AWS incidence in burn patients is low, and its incidence is closely correlated with burn severity, predominantly affecting males over 40 years old with prolonged alcohol use and severe burns. The AWS symptoms appear later and are easily masked by symptoms of burn complications, making it easy to misdiagnose or even miss the diagnosis. Therefore, clinicians should strengthen the screening of alcohol drinking history in male severe burn patients over 40 years old, and consult with physicians of relevant disciplines in a timely manner to ensure early diagnosis and intervention to reduce the risks of misdiagnosis or missed diagnosis and to improve prognosis.