Not every patient with an AUD will progress to
withdrawal, just as not every patient who undergoes
withdrawal progresses to delirium tremens.26 Thus,
being able to predict who is and who is not at greater
risk for withdrawal would be advantageous. Multiple
risk factors, including a history of withdrawal seizures,
structural brain lesions, multiple detoxifi cation episodes,
and severe withdrawal or delirium tremens during past
withdrawals have been predictive of future severe withdrawal.27,28
A process known as “kindling” is postulated
to be responsible for the increasing severity of withdrawal
with each detoxifi cation episode.29 Some researchers
have taken these prediction factors and devised tools for
identifying patients at risk for more severe withdrawal.
Maldonado et al28 recently devised the Prediction of
Alcohol Withdrawal Severity Scale; the scale is based on
10 factors identifi ed through the literature. Unfortunately,
this scale was validated in medical inpatients only, and
so its use in ICU patients is limited. Although research
on risk factors in ICU patients is limited, care providers
generally accept that patients who have experienced severe
withdrawal, delirium tremens, or seizures during past