AST: A Simplified 3-item Tool for Managing Alcohol Withdrawal

Area of Science:

• Clinical Medicine
• Psychiatry
• Pharmacology

Background:

• Alcohol withdrawal syndrome (AWS) management relies on symptom-triggered protocols.
• The Revised Clinical Institute Withdrawal Assessment Scale (CIWA-Ar) is the current standard for AWS assessment.
• There is a need for validated, reliable scales to accurately assess AWS severity.

Purpose of the Study:

• To compare the efficacy of the Glasgow Modified Alcohol Withdrawal Scale (GMAWS) and a novel 3-item Anxiety Sweats Tremor (AST) scale against the CIWA-Ar.
• To evaluate the internal consistency, inter-item correlation, and operational characteristics of the AST and GMAWS scales.
• To determine if the AST scale can reliably identify patients with significant alcohol withdrawal.

Main Methods:

• A comparative observational study involving 332 serial evaluations from 85 unique patients over two 1-week periods.
• Patients were managed per hospital protocol using CIWA-Ar, with supplemental scoring by GMAWS and AST.
• Internal consistency (Cronbach's alpha) and receiver-operating characteristic (ROC) curve analysis were performed.

Main Results:

• The AST scale exhibited significantly better internal consistency (Cronbach's alpha = 0.68) compared to CIWA-Ar (0.46) and GMAWS (0.41).
• AST reliably identified patients with CIWA-Ar scores ≥8 (area under the ROC curve = 0.83).
• An AST score of ≥3 predicted CIWA-Ar ≥8 with 93% sensitivity and 63% specificity.

Conclusions:

• The 3-item AST scale is a simple, reliable tool for assessing alcohol withdrawal syndrome.
• AST demonstrates good internal consistency and effectively identifies significant alcohol withdrawal.
• Further validation in diverse clinical settings and patient populations is warranted.