{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:06:29Z","timestamp":1760238389245,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T00:00:00Z","timestamp":1658966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Alcohol withdrawal syndrome (AWS) represents an adverse consequence of chronic alcohol use that may lead to serious complications. Therefore, AWS requires timely attention based on its early recognition, where easy-to-apply diagnostic tools are desirable. Our aim was to characterize the performance of a short-scale AST (Anxiety, Sweats, Tremors) in patients from public general hospitals. We conducted a cross-sectional study of patients attended at the Emergency Department diagnosed with AWS. Three scales were applied: CIWA-Ar (Clinical Institute Retirement Assessment Scale-Revised), GMAWS (Glasgow Modified Alcohol Withdrawal Syndrome) and AST. Cronbach\u2019s alpha and Cohen\u2019s kappa tests were used for reliability and concordance. Factorial analysis and diagnostic performance including ROC curve were carried out. Sixty-eight males with a mean age of 41.2 years old, with high school education and robust alcohol consumption, were included. Mean scores for CIWA-Ar, GMWAS and AST were 17.4 \u00b1 11.2, 3.9 \u00b1 2.3 and 3.8 \u00b1 2.6, respectively, without significant differences. The AST scale showed an acceptable reliability and concordance (0.852 and 0.439; p &lt; 0.0001) compared with CIWA-Ar and GMAWS. AST component analysis evidenced tremor (77.5% variance), sweat (12.1% variance) and anxiety (10.4% variance). Diagnostic performance of the AST scale was similar to the GMAWS scale, evidencing a sensitivity of 84%, specificity of 83.3% and Area Under the Curve (AUC) of 0.837 to discriminate severe AWS, according to CIWA-Ar. The performance of the AST scale to evaluate AWS is comparable with the commonly used CIWA-Ar and GMAWS scales. AST further represents an easy-to-apply instrument.<\/jats:p>","DOI":"10.3390\/ijerph19159208","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T03:21:16Z","timestamp":1658978476000},"page":"9208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance of AST Scale in Mexican Male Population for Alcohol Withdrawal Syndrome"],"prefix":"10.3390","volume":"19","author":[{"given":"Juan Antonio","family":"Su\u00e1rez-Cuenca","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico"},{"name":"Department of Clinical Research, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7418-1228","authenticated-orcid":false,"given":"Christian Gabriel","family":"Toledo-Lozano","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryjose Daniela","family":"Espinosa-Arroyo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nallely Alejandra","family":"V\u00e1zquez-Aguirre","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9881-7523","authenticated-orcid":false,"given":"Gandhy Thomas","family":"Fonseca-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Nephrology Department, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Garro-Almendaro","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Melchor-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor Hugo","family":"Garc\u00eda-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital General Tl\u00e1huac, SEDESA, Mexico City 13278, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abril","family":"Ortiz-Matamoros","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania","family":"Ortega-Rosas","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia Lizeth","family":"Alcaraz-Estrada","sequence":"additional","affiliation":[{"name":"Department of Genomic Medicine, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Mondrag\u00f3n-Ter\u00e1n","sequence":"additional","affiliation":[{"name":"Coordination of Research, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1760-3150","authenticated-orcid":false,"given":"Silvia","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Centro M\u00e9dico Nacional \u201c20 de Noviembre\u201d, ISSSTE, Mexico City 03229, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,28]]},"reference":[{"key":"ref_1","unstructured":"(2022, March 01). World Health Organization Alcohol. Available online: https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/alcohol."},{"key":"ref_2","unstructured":"Pan American Health Organization (2008). Alcohol y Atenci\u00f3n Primaria de la Salud: Informaciones Cl\u00ednicas B\u00e1sicas para la Identificaci\u00f3n y el Manejo de Riesgos y Problemas, Pan American Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/S0140-6736(19)31775-1","article-title":"Alcohol use disorders","volume":"394","author":"Carvalho","year":"2019","journal-title":"Lancet"},{"key":"ref_4","unstructured":"GBD 2016 Alcohol Collaborators (2018). Alcohol use and burden for 195 countries and territories, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet, 392, 1015\u20131035."},{"key":"ref_5","unstructured":"World Health Organization (2018). Global Status Report on Alcohol and Health 2018: Executive Summary, World Health Organization."},{"key":"ref_6","unstructured":"Center for Behavioral Health Statistics and Quality (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50)."},{"key":"ref_7","unstructured":"(2022, January 08). National Institute on Alcohol And Alcoholism Alcohol Facts and Statistics|National Institute on Alcohol Abuse and Alcoholism (NIAAA), Available online: https:\/\/www.niaaa.nih.gov\/publications\/brochures-and-fact-sheets\/alcohol-facts-and-statistics."},{"key":"ref_8","unstructured":"(2022, March 01). Comisi\u00f3n Nacional Contra las Adicciones. 15 de Noviembre, D\u00eda Nacional Contra el Uso Nocivo del Alcohol, Available online: https:\/\/www.gob.mx\/salud\/conadic\/acciones-y-programas\/15-de-noviembre-dia-nacional-contra-el-uso-nocivo-del-alcohol."},{"key":"ref_9","unstructured":"Reynales-Shigematsu, L., Zavala-Arciniega, L., Paz-Ballesteros, W., Guti\u00e9rrez-Torres, D., Garc\u00eda-Buend\u00eda, J., and Rodriguez-Andrade, M. (2017). Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016\u20132017: Reporte de Drogas."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Vigouroux, A., Garret, C., Lascarrou, J.B., Martin, M., Miailhe, A.F., Lemari\u00e9, J., Dupeyrat, J., Zambon, O., Seguin, A., and Reignier, J. (2021). Alcohol withdrawal syndrome in ICU patients: Clinical features, management, and outcome predictors. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0261443"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e910","DOI":"10.1212\/WNL.0000000000009848","article-title":"Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy","volume":"95","author":"Benussi","year":"2020","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e204687","DOI":"10.1001\/jamanetworkopen.2020.4687","article-title":"Associations Between Medical Conditions and Alcohol Consumption Levels in an Adult Primary Care Population","volume":"3","author":"Sterling","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1378\/chest.09-1425","article-title":"Alcohol-Use Disorders in the Critically Ill Patient","volume":"138","author":"Jones","year":"2010","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1176\/appi.psy.49.4.292","article-title":"Successful implementation of an alcohol-withdrawal pathway in a general hospital","volume":"49","author":"Stern","year":"2008","journal-title":"Psychosomatics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1097\/ADM.0000000000000576","article-title":"Prevalence and Variation of Clinically Recognized Inpatient Alcohol Withdrawal Syndrome in the Veterans Health Administration","volume":"14","author":"Steel","year":"2020","journal-title":"J. Addict. Med."},{"key":"ref_16","first-page":"562","article-title":"Alcohol as a Means for the prevention of disturbances in surgical intensive care medicine","volume":"55","author":"Stuppe","year":"2020","journal-title":"Anasthesiol. Intensivmed. Notfallmed. Schmerzther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/ane.12671","article-title":"Alcohol withdrawal syndrome: Mechanisms, manifestations, and management","volume":"135","author":"Jesse","year":"2017","journal-title":"Acta Neurol. Scand."},{"key":"ref_18","unstructured":"Manning, V., Arunogiri, S., Frei, M., Ridley, K., Mroz, K., Campbell, S., and Lubman, D. (2018). Alcohol and other Drug Withdrawal: Practice Guidelines."},{"key":"ref_19","first-page":"1","article-title":"Alcohol withdrawal syndrome: Improving outcomes in the emergency department with aggressive management strategies","volume":"23","author":"Yanta","year":"2021","journal-title":"Emerg. Med. Pract."},{"key":"ref_20","first-page":"118","article-title":"Alcohol withdrawal syndrome: Diagnostic and therapeutic methods","volume":"53","author":"Attilia","year":"2018","journal-title":"Riv. Psichiatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1111\/j.1399-6576.2005.00839.x","article-title":"The proportion of intensive care unit admissions related to alcohol use: A prospective cohort study","volume":"49","author":"Uusaro","year":"2005","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"44","DOI":"10.5507\/bp.2013.089","article-title":"Alcohol withdrawal delirium\u2014Diagnosis, course and treatment","volume":"159","author":"Mainerova","year":"2015","journal-title":"Biomed. Pap. Med. Fac. Univ. Palacky. Olomouc. Czech. Repub."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2664","DOI":"10.1111\/acer.12529","article-title":"Predictors of Severe Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis","volume":"38","author":"Goodson","year":"2014","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1177\/1060028016629161","article-title":"Treatment of Severe Alcohol Withdrawal","volume":"50","author":"Schmidt","year":"2016","journal-title":"Ann. Pharmacother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/S0140-6736(09)60009-X","article-title":"Alcohol-use disorders","volume":"373","author":"Schuckit","year":"2009","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.revmed.2020.10.383","article-title":"Delirium tremens: Quoi de neuf pour une vieille maladie?","volume":"42","author":"Thiercelin","year":"2021","journal-title":"La Rev. M\u00e9d. Interne"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/alcalc\/37.1.61","article-title":"The FAST Alcohol Screening Test","volume":"37","author":"Hodgson","year":"2002","journal-title":"Alcohol Alcohol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"40","DOI":"10.4037\/ccn2005.25.3.40","article-title":"Alcohol withdrawal syndrome overlooked and mismanaged?","volume":"25","author":"McKinley","year":"2005","journal-title":"Crit. Care Nurse"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/ADM.0000000000000215","article-title":"AST: A simplified 3-item tool for managing alcohol withdrawal","volume":"10","author":"Holzman","year":"2016","journal-title":"J. Addict. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.revmed.2019.02.001","article-title":"Alcohol withdrawal syndrome management: Is there anything new?","volume":"40","author":"Airagnes","year":"2019","journal-title":"La Rev. Med. Interne"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"53","DOI":"10.2147\/OAEM.S235288","article-title":"Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives","volume":"12","author":"Wolf","year":"2020","journal-title":"Open Access Emerg. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"52","DOI":"10.5144\/0256-4947.2022.52","article-title":"Clinical characteristics and health outcomes in patients with alcohol withdrawal syndrome: An observational study from Oman","volume":"42","year":"2022","journal-title":"Ann. Saudi Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1001\/jama.1997.03550020076042","article-title":"Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal","volume":"278","year":"1997","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/00004714-198111000-00006","article-title":"Development of optimal treatment tactics for alcohol withdrawal. I. Assessment and effectiveness of supportive care","volume":"1","author":"Shaw","year":"1981","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1111\/j.1360-0443.1989.tb00737.x","article-title":"Assessment of alcohol withdrawal: The revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar)","volume":"84","author":"Sullivan","year":"1989","journal-title":"Br. J. Addict."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1080\/13556210500224015","article-title":"Oxcarbazepine versus carbamazepine in the treatment of alcohol withdrawal","volume":"10","author":"Schik","year":"2005","journal-title":"Addict. Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1111\/j.1360-0443.1994.tb03307.x","article-title":"Assessment of the alcohol withdrawal syndrome\u2014Validity and reliability of the translated and modified Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-A)","volume":"89","author":"Stuppaeck","year":"1994","journal-title":"Addiction"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1093\/alcalc\/36.2.104","article-title":"A comparison of rating scales for the alcohol-withdrawal syndrome","volume":"36","author":"Williams","year":"2001","journal-title":"Alcohol Alcohol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1093\/qjmed\/hcs020","article-title":"Appraisal of the Glasgow assessment and management of alcohol guideline: A comprehensive alcohol management protocol for use in general hospitals","volume":"105","author":"McPherson","year":"2012","journal-title":"QJM"},{"key":"ref_40","first-page":"103","article-title":"Validaci\u00f3n de la escala CIWA en pacientes mexicanos con s\u00edndrome de supresi\u00f3n alcoh\u00f3lica","volume":"28","year":"2012","journal-title":"Med. Interna Mex."},{"key":"ref_41","first-page":"691","article-title":"Clinical Institute Withdrawal Assessment for Alcohol\u2013Revised might be an unreliable tool in the management of alcohol withdrawal","volume":"63","author":"Knight","year":"2017","journal-title":"Can. Fam. Physician"},{"key":"ref_42","first-page":"e15373","article-title":"Iatrogenic Delirium in Patients on Symptom-Triggered Alcohol Withdrawal Protocol: A Case Series","volume":"13","author":"Wang","year":"2021","journal-title":"Cureus"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1080\/135562101200100571","article-title":"A Short Alcohol Withdrawal Scale (SAWS): Development and psychometric properties","volume":"7","author":"Gossop","year":"2002","journal-title":"Addict. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1445-5994.2006.01032.x","article-title":"Clinical use of a shortened alcohol withdrawal scale in a general hospital","volume":"36","author":"Foy","year":"2006","journal-title":"Intern. Med. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.aenj.2010.04.001","article-title":"Utilisation of a purpose-designed chart for the nursing management of acute alcohol withdrawal in the hospital setting","volume":"13","author":"Swift","year":"2010","journal-title":"Australas. Emerg. Nurs. J."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9208\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:57:53Z","timestamp":1760140673000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,28]]},"references-count":45,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph19159208"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19159208","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,7,28]]}}}