The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS)
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/30/-0001 |
| Start Date: | May 2012 |
| End Date: | March 2013 |
| Contact: | Yelizaveta Sher, M.D. |
| Email: | ysher@stanford.edu |
| Phone: | (650) 723-6661 |
The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS): Development and Psychometric Characteristics of a New Scale for the Prediction of Moderate to Severe Alcohol Withdrawal Syndrome.
Although there are several tools that can be used to evaluate the severity of ongoing
alcohol withdrawal syndrome (AWS), there is no available tool that can predict which
patients are at risk for developing AWS at the time admission, before the patient has
developed AWS. Unfortunately, there are severe symptoms of alcohol withdrawal (i.e.,
seizures) which may develop early in the hospitalization, and before the development of
other systemic symptoms which may warn medical personnel of the possibility of impeding
alcohol withdrawal (i.e., autonomic instability). The goal of this study is to evaluate the
psychometric properties (e.g., predictive validity) of the new tool, the Prediction of
Alcohol Withdrawal Severity Scale (PAWSS), on identifying which patients are at risk for
developing moderate to severe AWS (i.e., seizures, hallucinosis, delitium tremens) during
admission to a medical unit.
The investigators plan to study the psychometric properties of a new tool, the "Prediction
of Alcohol Withdrawal Severity Scale" (PAWSS) on predicting the risk for the development of
moderate to severe AWS in hospitalized medical patients. This tool was developed through an
extensive literature review which identified evidence-based predictors for AWS.
The scale consists of three portions relating to 1) an initial screening (threshold items),
2) patient's history of alcohol use and its consequences, and 3) measures of BAL and
autonomic function. The investigators predict that a scale score 3 or greater will be
associated with a high risk for the development of moderate to severe AWS.
Patients will be undergo examination with the PAWSS within 24 hours of admission.
Thereafter, all patients will undergo daily examinations with the Clinical Institute
Withdrawal Assessment (CIWA) and Alcohol Withdrawal Severity scale (AWSS) in order to
measure the primary outcomes of the study, that is, the development and severity (i.e.,
moderate to severe) of AWS during the first 72-hours after admission. The study is designed
to study the SIPAT-tool's psychometirc properties including its validity and inter-rater
reliability.
By providing clinicians with a tool (i.e., PAWSS) that allows them to correctly predict who
will develop moderate-severe AWS it will enable them to prophylax (i.e., preventively treat)
patients at risk and thus decrease patients' morbidity and mortality, length of hospital
stay, and minimize the significant burden on the nursing and medical staff.
Inclusion Criteria:
- All patients admitted to the B2 and B3 Stanford Hospital inpatient units, directly
from the Stanford ED or outpatient/community settings.
- Ability to communicate in English.
- Ability to understand our questionnaire.
- Willingness to consent and participate.
Exclusion Criteria:
- Patients transferred from other units within Stanford Hospital, or from outside
hospitals.
- Inability to understand our questionnaire.
- Unwilling to consent and participate.
- Patients in active alcohol withdrawal, as defined by CIWA > 20 on admission.
- Patients with uncontrolled seizure disorder.
- Patients with severe personality disorder.
- Patients with an imminent discharge plan (within 48 hours of study screening).
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