Should a Patient Who Requests Alcohol Detoxification Be Admitted or Treated as Outpatient?

Key Points

• Not all patients presenting for alcohol detoxification need to be admitted.
• Tools that may assist the hospitalist in determining inpatient versus outpatient therapy include the PAWSS tool and an initial CIWA score.
• Although PAWSS was designed to identify medically ill hospitalized patients at risk for developing complicated AWS, it may be a potential tool to estimate risk for complicated AWS when determining whether to admit patients to the hospital for detoxification.
• Only 20% of patients with alcohol withdrawal syndrome will develop severe symptoms of AWS.

Additional Reading

1. Stephens JR, Liles AE, Dancel R, Gilchrist M, Kirsch J, DeWalt DA. Who needs inpatient detox? Development and implementation of a hospitalist protocol for the evaluation of patients for alcohol detoxification. J Gen Intern Med. 2014;29(4):587-593.
2. Maldonado JR, Sher Y, Ashouri JF, 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.