We have read with a great interest the article “Validation of the Withdrawal Assessment Tool-1 in Adult Intensive Care Patients,”1  by Capilnean and colleagues. The study emphasizes the importance of a validated tool to detect opioid withdrawal syndrome in adult intensive care units (ICUs), and yet we wonder if one possible explanation for the low accuracy of the Withdrawal Assessment Tool (WAT-1) in their study was that they included all patients with brain injury and a score of 9 or greater on the Glasgow Coma Scale (GCS) if the patient’s intracranial pressure was not increased. Although the number of patients in the study with nervous system disorders as the cause of admission to the ICU was low, we note that such patients made up nearly 15% of the patients in the study who had iatrogenic withdrawal syndrome.

Although we suspect that using such broad inclusion criteria is a logical...

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