BACKGROUND: Thiamine deficiency in patients who abuse alcohol can cause 
Wernicke's encephalopathy (WE). Thiamine supplements are given to prevent this 
complication. Guidelines exist for giving thiamine supplementation in the 
inpatient population. However, similar guidelines are not available for 
clinicians detoxifying patients in the community, and consequently, assessment 
of risk of WE and prophylaxis can be inconsistent.
METHODS: A scoring system to assess risk of WE was developed and evaluated by 
comparing practice before and after introduction of the system. One hundred and 
twenty-six cases requiring alcohol detoxification were examined: 94 before 
introduction of the scoring system and 32 afterward.
RESULTS: Before introduction of the scoring system, a risk assessment for 
developing WE was performed in 30% of patients and parenteral thiamine 
prescribed in 32%. After introduction of the scoring system, risk assessment and 
administration of parenteral thiamine increased to 100 and 75%, respectively. 
There was 1 probable case of WE before introduction of the scoring system and 
none afterward.
CONCLUSIONS: We conclude that assessment of WE is often inadequate, leading to 
inadequate thiamine administration. The new scoring system allows simple, 
structured risk assessment for WE and thus guides appropriate thiamine 
administration. This is of most value to clinicians treating the consequences of 
alcohol dependence in the community.