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Prevention of alcohol withdrawal syndrome in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document
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  • Published on:
    Using BAWS in ICUs
    • Darius A. Rastegar, Addiction Medicine Physician Johns Hopkins University School of Medicine

    In their review of surveillance methods for alcohol withdrawal syndrome (AWS) in the surgical ICU, the authors state that both the CIWA-Ar and BAWS scales “are not validated in critically ill, medically complex, or postoperative patients.” They correctly point out that one of the limitations of the CIWA-Ar is that most items require the patient to answer questions. They recommend the mMINDS tool because it “does not require the patient to answer questions.”

    First, I would like to point out that the BAWS has been studied in critically ill patients – we published a report on 279 admissions to intensive care units at two hospitals where the BAWS was used to guide treatment (1). Second, while both the BAWS and mMINDS rely more on observation that patient report, both include assessment of orientation and hallucinations (plus delusions with mMINDS), which requires a patient to answer questions.

    1. Rastegar DA, Jarrell AS, Chen ES. Implementation of an alcohol withdrawal protocol using the 5-item Brief Alcohol Withdrawal Scale for treatment of severe withdrawal in Intensive Care Units. J Intens Care Med 2021;36:1361-65.

    Conflict of Interest:
    I was part of the group that developed BAWS.