From the Guidelines
A safe discharge Clinical Institute Withdrawal Assessment (CIWA) score for a patient with alcohol withdrawal syndrome is 8 or below, as indicated by a score >8 suggesting moderate AWS and a score ≥15 indicating severe AWS 1. When considering discharge, it's crucial to assess the patient's overall clinical stability, ensuring they have minimal withdrawal symptoms, normal vital signs, and can tolerate oral intake.
- Key factors to consider before discharge include:
- The patient's CIWA score consistently being below 8 for at least 24 hours without needing medication for withdrawal symptoms.
- The absence of other medical or psychiatric issues that require inpatient care.
- The presence of a comprehensive follow-up plan, including outpatient addiction treatment, counseling, and possibly medications to support alcohol abstinence. The CIWA score threshold of 8 is significant because scores below this level typically indicate mild withdrawal symptoms that can be safely managed in an outpatient setting 1.
- It's also important to educate patients about:
- The risk of recurrent withdrawal.
- The importance of abstinence.
- When to seek medical attention if symptoms worsen after discharge. By prioritizing these factors and ensuring a CIWA score of 8 or below, clinicians can safely discharge patients with alcohol withdrawal syndrome, minimizing the risk of morbidity, mortality, and improving quality of life 1.
From the Research
Safe Discharge CIWA Score
The safe discharge Clinical Institute Withdrawal Assessment (CIWA) score for a patient with alcohol withdrawal syndrome is a topic of discussion in several studies.
- A study published in 2004 2 suggests that a CIWA-Ar score of less than 10 may indicate that a patient can be safely discharged without benzodiazepine treatment.
- Another study from 1991 3 found that patients with a CIWA score greater than 10 required more benzodiazepine medication, implying that a score below 10 may be a safe threshold for discharge.
- However, it is essential to note that the CIWA score is just one factor to consider when determining safe discharge, and clinical judgment should also be taken into account.
CIWA Score and Benzodiazepine Treatment
The relationship between CIWA score and benzodiazepine treatment is explored in several studies.
- A 1991 study 3 found that using the CIWA scale to guide benzodiazepine treatment resulted in lower doses of medication being administered to patients.
- A 2004 study 2 also found that using the CIWA-Ar scale to guide treatment helped to minimize the over-utilization of benzodiazepines in patients with alcohol withdrawal syndrome.
- A 1997 study 4 developed a new rating scale for assessing alcohol withdrawal syndrome, which found that a score of 10 or higher was associated with a higher risk of complications.
Comparison of CIWA Scales
Different studies have used various versions of the CIWA scale, including the CIWA-A, CIWA-Ar, and a 5-item Brief Alcohol Withdrawal Scale (BAWS).
- A 2017 study 5 compared the BAWS with the CIWA-Ar and found that a BAWS score of 3 or more predicted a CIWA-Ar score of 8 or higher with good sensitivity and specificity.
- The study also found that using the BAWS scale resulted in lower doses of diazepam being administered to patients.