From the Guidelines
The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the scoring system used to assess the severity of alcohol withdrawal symptoms. This scoring system is useful in clinical practice, as stated in the Journal of Hepatology 1. The CIWA-Ar score helps clinicians determine the severity of alcohol withdrawal symptoms, with a score >8 indicating moderate withdrawal and a score ≥15 indicating severe withdrawal.
Key Points
- The CIWA-Ar is a 10-item scale that evaluates symptoms such as nausea/vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, and orientation.
- Each item is scored from 0-7 points (except orientation, which is scored 0-4), with a maximum total score of 67.
- Scores below 10 indicate mild withdrawal, 10-18 indicate moderate withdrawal requiring medication, and scores above 18 indicate severe withdrawal with risk of delirium tremens and seizures.
- The CIWA-Ar helps clinicians determine appropriate treatment intensity, with benzodiazepines like lorazepam or diazepam typically administered for scores above 10, often using a symptom-triggered approach, as recommended by the Journal of Hepatology 1 and Clinical and Molecular Hepatology 1.
Treatment Approach
- The scale should be administered every 1-2 hours initially for patients in active withdrawal, with frequency decreasing as symptoms improve.
- The CIWA-Ar is valuable because it provides an objective measure of withdrawal severity, allows for standardized treatment protocols, and helps prevent both under-treatment (which risks seizures and delirium tremens) and over-treatment (which risks respiratory depression and excessive sedation), as noted in the Journal of Hepatology 1 and Journal of Hepatology 1.
From the Research
Scoring System for Alcohol Withdrawal
The scoring system used to assess the severity of alcohol withdrawal symptoms is called the Clinical Institute Withdrawal Assessment for Alcohol - Revised (CIWA-Ar) [ 2, 3, 4, 5, 6 ].
Key Features of CIWA-Ar
- The CIWA-Ar is a widely used tool to quantify alcohol withdrawal syndrome (AWS) severity and inform benzodiazepine treatment for alcohol withdrawal [ 2, 4 ].
- The assessment tool evaluates various symptoms, including nausea, tremors, and anxiety, to determine the severity of alcohol withdrawal [ 3 ].
- A higher CIWA-Ar score indicates more severe withdrawal symptoms, with scores ≥ 10 often requiring benzodiazepine treatment [ 2 ].
Application of CIWA-Ar in Clinical Settings
- The CIWA-Ar has been used in various studies to evaluate the effectiveness of different treatment approaches for alcohol withdrawal, including benzodiazepine and non-benzodiazepine therapies [ 3, 5 ].
- The assessment tool has been implemented in hospital settings to guide treatment decisions and reduce the risk of adverse events [ 4, 6 ].
- Studies have shown that the use of CIWA-Ar can lead to reduced benzodiazepine use and improved patient outcomes [ 6 ].