Prediction of Alcohol Withdrawal Severity Scale (PAWSS)
10-item tool to predict risk of complicated alcohol withdrawal (seizures, delirium tremens) before symptoms develop. Score ≥4 = high risk requiring prophylactic benzodiazepines.
Score interpretation
PAWSS 0–3 — low risk of complicated alcohol withdrawal
→ Standard monitoring; oral thiamine; symptom-triggered benzodiazepines (CIWA-Ar guided); reassess at 6 and 12 hours
PAWSS ≥4 — high risk of seizure or delirium tremens
→ Prophylactic benzodiazepine regimen (fixed-schedule diazepam or chlordiazepoxide); IV thiamine (Pabrinex 2 pairs TDS × 2 days); admit to monitored bed; seizure precautions; may require ICU-level care if deteriorates
Interpretation bands for the PAWSS. Apply clinical judgement and local guidance.
References
- Maldonado JR et al. The Prediction of Alcohol Withdrawal Severity Scale (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol. 2014;48(4):375–390.
Related
Curated clinical cross-links plus same-class fallbacks.
- Chlorhexidine gluconate with isopropyl alcohol · Skin antiseptic
- Chlorhexidine · Antiseptic / disinfectant (bisbiguanide)
- Alcohol (ethanol) · Antidote / sclerosant
- Haloperidol (Delirium) · Typical Antipsychotic (Butyrophenone)
- Polyvinyl alcohol · Ocular lubricant
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.