psychiatry emergency

Brief Alcohol Withdrawal Scale (BAWS)

5-item Brief Alcohol Withdrawal Scale (tremor, sweats, agitation, confusion/orientation, hallucinations; each 0–3, total 0–15) for symptom-triggered treatment (Rastegar 2017). BAWS ≥ 3 triggers treatment.

Score interpretation

BAWS 0–2 — No Treatment Needed Now 0–2

Below the BAWS treatment threshold

→ Reassess every 4–6 h. Oral hydration, close monitoring; consider PRN benzodiazepine; no routine scheduled benzodiazepines needed. Adults: thiamine 100 mg IM/IV. Children: use a children's formulary.

BAWS 3–5 — Withdrawal Needing Treatment 3–5

Withdrawal at the BAWS treatment threshold

→ Symptom-triggered benzodiazepine per local protocol, reassessing every 4 h until BAWS < 3. Adults: thiamine 200–500 mg IV. Children: use a children's formulary.

BAWS ≥ 6 — Severe Withdrawal 6–15

Severe alcohol withdrawal (BAWS ≥ 6); delirium tremens risk

→ Benzodiazepine every 2 h until BAWS < 6 and notify the physician if > 8 (BAWS protocol). Medical emergency: HDU/ICU admission; seizure precautions; correct electrolytes (Mg, K, phosphate). Adults: IV benzodiazepines (diazepam 10 mg IV PRN, titrated); thiamine 500 mg IV TDS × 3 days. Children: use a children's formulary.

Interpretation bands for the BAWS. Apply clinical judgement and local guidance.

References

Rastegar DA, et al. Development and implementation of an alcohol withdrawal protocol using a 5-item scale, the Brief Alcohol Withdrawal Scale (BAWS). Subst Abus. 2017;38(4):394–400.
Rastegar DA, et al. Implementation of a protocol using the 5-item Brief Alcohol Withdrawal Scale for treatment of severe alcohol withdrawal in intensive care units. J Intensive Care Med. 2021;36(11):1361–1365.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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