Alcohol withdrawal syndrome (AWS) presents with a nonspecific autonomic/behavioural picture — sweating, tachycardia, tremor, agitation, anxiety. None of these findings are unique to withdrawal. In hospital, the diagnosis is confirmed with bloods (ethanol level, glucose, U&Es, LFTs, infection markers, sometimes a tox screen) before a severity tool is applied. Prehospitally, none of that data exists — the diagnosis is being assumed on pattern recognition alone, in a differential that includes several more immediately dangerous mimics.
Developed and validated on an inpatient ward, in a population where AWS is already diagnosed, with hourly reassessment and immediate prescribing backup. No prehospital validation exists.
Designed to answer "has the last dose worked" in someone already confirmed to be withdrawing — needs serial scores over time. A single on-scene score has limited meaning and implies false precision on a PRF.
Scores severity within an assumed diagnosis of AWS. Will generate a reassuring low score in a patient who is actually septic, hypoglycaemic, or in another differential entirely — it has no mechanism to flag that.
Overlap: sweating, tachycardia, agitation, tremor, confusion.
Distinguish: point-of-care glucose — the one thing you genuinely can check on scene. Do this first, always.
Overlap: tachycardia, sweating, agitation/confusion, tremor (rigors).
Distinguish: fever/hypothermia, source history, hypotension, raised RR, NEWS2 trend — none of which a withdrawal-only frame will prompt you to check.
Overlap: tremor, agitation, lowers seizure threshold independently.
Distinguish: not detectable on scene — bloods only. Relevant because chronic heavy drinkers are commonly electrolyte-depleted regardless of withdrawal stage.
Overlap: agitation, confusion, behavioural change — especially in known cirrhotics.
Distinguish: orientation and short-term recall (HE tends toward disorientation/poor retention rather than pure autonomic signs), jaundice, asterixis, known liver disease history. See West Haven reference.
Overlap: tachycardia, sweating, tremor, agitation.
Distinguish: history of thyroid disease, goitre, heat intolerance, weight loss — not excludable on scene without history/collateral.
Overlap: tachycardia, agitation, sweating, hypertension.
Distinguish: collateral/scene history, pupil size, concurrent substance use — polysubstance use is common in this population, so presence of alcohol history doesn't exclude this.
Overlap: agitation, tremor, sweating, tachycardia.
Distinguish: medication history (SSRIs/SNRIs, tramadol, MAOIs), clonus/hyperreflexia if examined — easy to miss without specifically asking about medications.
Overlap: agitation, autonomic instability, confusion.
Distinguish: antipsychotic history, rigidity, hyperthermia — rare, but part of the same nonspecific picture and worth a mental checkbox.
| Check | Why |
|---|---|
| Blood glucose | Rules in/out the most immediately dangerous and easily-missed mimic. Do this before anything else. |
| Full obs set + trend | HR, BP, RR, temp, SpO2, GCS — fever or hypotension point away from simple withdrawal. |
| Orientation + short-term recall | Helps separate autonomic-only withdrawal picture from an encephalopathic/delirium process. |
| Collateral history | Prior withdrawal seizures or DTs, known liver disease, other substance use, medication changes. |
| Seizure history this episode or previously | Single strongest predictor of recurrence — should push toward conveyance regardless of current severity. |
| Social context | Living alone, capacity, ability to engage with same-day follow-up. |