Clinical Opiate Withdrawal Scale (COWS)

Clinical Opiate Withdrawal Scale
Patient's Name: [text name="variable_1"]
Date and Time: [date name="variable_2" default="timestamp"]
Reason for this assessment: [textarea name="variable_3"]
For each item below, select the choice that best describes the patient's signs or symptom.Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increase pulse rate would not add to the score.
[select name="variable_4" value="0|1|2|3|4"] <-- Resting Pulse Rate (beats/minute)
Measured after patient is sitting or lying for one minute.
0 pulse rate 80 or below
1 pulse rate 81-1 00
2 pulse rate 101-120
4 pulse rate greater than 120
[select name="variable_5" value="0|1|2|3|4"] <-- Sweating
Over past 1/2 hour not accounted for by room temperature or patient activity.
0 no report of chills or flushing
1 subjective report of chills or flushing
2 flushed or observable moistness on face
3 beads of sweat on brow or face
4 sweat streaming off face
[select name="variable_6" value="0|1|3|5"] <-- Restlessness
Observation during assessment.
0 able to sit still
1 reports difficulty sitting still, but is able to do so
3 frequent shifting or extraneous movements of legs/arms
5 unable to sit still for more than a few seconds
[select name="variable_7" value="0|1|2|5"] <-- Pupil size
0 pupils pinned or normal size for room light
1 pupils possibly larger than normal for room light
2 pupils moderately dilated
5 pupils so dilated that only the rim of the iris is visible
[select name="variable_8" value="0|1|2|4"] <-- Bone or Joint aches
If patient was having pain previously, only the additional component attributed to opiates withdrawal is scored.
0 not present
1 mild diffuse discomfort
2 patient reports severe diffuse aching of joints/muscles
4 patient is rubbing joints or muscles and is unable to sit still because of discomfort
[select name="variable_9" value="0|1|2|4"] <-- Runny nose or tearing
Not accounted for by cold symptoms or allergies.
0 not present
1 nasal stuffiness or unusually moist eyes
2 nose running or tearing
4 nose constantly running or tears streaming down cheeks
[select name="variable_10" value="0|1|2|3|5"] <-- GI Upset
Over last 1/2 hour.
0 no GI symptoms
1 stomach cramps
2 nausea or loose stool
3 vomiting or diarrhea
5 multiple episodes of diarrhea or vomiting
[select name="variable_11" value="0|1|2|4"] <-- Tremor
Observation of outstretched hands.
0 no tremor
1 tremor can be felt, but not observed
2 slight tremor observable
4 gross tremor or muscle twitching
[select name="variable_12" value="0|1|2|4"] <-- Yawning
Observation during assessment.
0 no yawning
1 yawning once or twice during assessment
2 yawning three or more times during assessment
4 yawning several times/minute
[select name="variable_13" value="0|1|2|4"] <-- Anxiety or Irritability
0 none
1 patient reports increasing irritability or anxiousness
2 patient obviously irritable or anxious
4 patient so irritable or anxious that participation in the assessment is difficult
[select name="variable_14" value="0|3|5"] <-- Gooseflesh skin
0 skin is smooth
3 piloerection of skin can be felt or hairs standing up on arms
5 prominent piloerection
Total Score (The total score is the sum of all 11 items) --> [calc memo="score" value="score_1=(variable_4)+(variable_5)+(variable_6)+(variable_7)+(variable_8)+(variable_9)+(variable_10)+(variable_11)+(variable_12)+(variable_13)+(variable_14)"]
Interpretation (5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal) --> [calc memo="result" value="score_2=(variable_4)+(variable_5)+(variable_6)+(variable_7)+(variable_8)+(variable_9)+(variable_10)+(variable_11)+(variable_12)+(variable_13)+(variable_14);score_2>36?'severe withdrawal':score_2>24?'moderately severe withdrawal':score_2>12?'moderate withdrawal':score_2>4?'mild withdrawal':'minimal or no withdrawal'"]
Initials of person completing assessment: [text name="variable_15"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference:
[link url="//pubmed.ncbi.nlm.nih.gov/12924748/" memo="#1"] Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003 Apr-Jun;35(2):253-9. doi: 10.1080/02791072.2003.10400007. PMID: 12924748.[/conditional]
Clinical Opiate Withdrawal Scale
Patient's Name:
Date and Time:
Reason for this assessment:
For each item below, select the choice that best describes the patient's signs or symptom.Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increase pulse rate would not add to the score.
<-- Resting Pulse Rate (beats/minute)
Measured after patient is sitting or lying for one minute.
0 pulse rate 80 or below
1 pulse rate 81-1 00
2 pulse rate 101-120
4 pulse rate greater than 120
<-- Sweating
Over past 1/2 hour not accounted for by room temperature or patient activity.
0 no report of chills or flushing
1 subjective report of chills or flushing
2 flushed or observable moistness on face
3 beads of sweat on brow or face
4 sweat streaming off face
<-- Restlessness
Observation during assessment.
0 able to sit still
1 reports difficulty sitting still, but is able to do so
3 frequent shifting or extraneous movements of legs/arms
5 unable to sit still for more than a few seconds
<-- Pupil size
0 pupils pinned or normal size for room light
1 pupils possibly larger than normal for room light
2 pupils moderately dilated
5 pupils so dilated that only the rim of the iris is visible
<-- Bone or Joint aches
If patient was having pain previously, only the additional component attributed to opiates withdrawal is scored.
0 not present
1 mild diffuse discomfort
2 patient reports severe diffuse aching of joints/muscles
4 patient is rubbing joints or muscles and is unable to sit still because of discomfort
<-- Runny nose or tearing
Not accounted for by cold symptoms or allergies.
0 not present
1 nasal stuffiness or unusually moist eyes
2 nose running or tearing
4 nose constantly running or tears streaming down cheeks
<-- GI Upset
Over last 1/2 hour.
0 no GI symptoms
1 stomach cramps
2 nausea or loose stool
3 vomiting or diarrhea
5 multiple episodes of diarrhea or vomiting
<-- Tremor
Observation of outstretched hands.
0 no tremor
1 tremor can be felt, but not observed
2 slight tremor observable
4 gross tremor or muscle twitching
<-- Yawning
Observation during assessment.
0 no yawning
1 yawning once or twice during assessment
2 yawning three or more times during assessment
4 yawning several times/minute
<-- Anxiety or Irritability
0 none
1 patient reports increasing irritability or anxiousness
2 patient obviously irritable or anxious
4 patient so irritable or anxious that participation in the assessment is difficult
<-- Gooseflesh skin
0 skin is smooth
3 piloerection of skin can be felt or hairs standing up on arms
5 prominent piloerection
Total Score (The total score is the sum of all 11 items) --> scorescore_1=(variable_4)+(variable_5)+(variable_6)+(variable_7)+(variable_8)+(variable_9)+(variable_10)+(variable_11)+(variable_12)+(variable_13)+(variable_14)
Interpretation (5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal) --> resultscore_2=(variable_4)+(variable_5)+(variable_6)+(variable_7)+(variable_8)+(variable_9)+(variable_10)+(variable_11)+(variable_12)+(variable_13)+(variable_14);score_2>36?'severe withdrawal':score_2>24?'moderately severe withdrawal':score_2>12?'moderate withdrawal':score_2>4?'mild withdrawal':'minimal or no withdrawal'
Initials of person completing assessment:
display/hide references

Result - Copy and paste this output:

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