From the Guidelines
The CIWA-Ar score is a useful tool in clinical practice for assessing the severity of alcohol withdrawal syndrome, with a score >8 indicating moderate AWS and a score ≥15 indicating severe AWS. The CIWA-Ar score is a standardized assessment tool that evaluates the severity of alcohol withdrawal symptoms, including symptoms such as increased blood pressure and pulse rate, tremors, hyperreflexia, irritability, anxiety, headache, nausea, and vomiting 1. The score helps clinicians determine the severity of withdrawal and guide treatment decisions, with higher scores indicating more severe withdrawal.
Key Points to Consider
- A CIWA-Ar score >8 indicates a moderate AWS and a score ≥15 indicates severe AWS 1
- Pharmacological treatment is recommended for both moderate and severe AWS using a symptom-triggered regimen rather than fixed dose schedule 1
- Benzodiazepines are considered the ‘gold standard’ treatment for AWS, given their efficacy for reducing both withdrawal symptoms and the risk of seizures and/or delirium tremens 1
- Regular reassessment using the CIWA scale allows for medication adjustments as withdrawal symptoms evolve, helping to prevent both under-treatment and over-medication with sedatives.
Treatment Approach
The treatment approach for alcohol withdrawal syndrome typically involves the use of benzodiazepines, such as diazepam, lorazepam, or chlordiazepoxide, administered either on a fixed schedule or symptom-triggered based on CIWA scores 1. The choice of benzodiazepine depends on the patient's individual needs, with long-acting benzodiazepines providing more protection against seizures and delirium, but short and intermediate-acting benzodiazepines being safer in elderly patients and those with hepatic dysfunction 1.
From the Research
CIWA Score Overview
- The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is a tool used to assess the severity of alcohol withdrawal syndrome (AWS) and guide treatment decisions 2, 3, 4.
- The CIWA-Ar score is calculated based on the patient's symptoms, such as tremors, agitation, and hallucinations, and can range from 0 to 67 2.
CIWA Score Interpretation
- A CIWA-Ar score of 10 or higher indicates moderate to severe AWS and may require benzodiazepine treatment 2.
- A score of less than 10 may indicate mild AWS, and the patient can be observed and reassessed regularly 2.
- The CIWA-Ar score can be used to monitor the patient's response to treatment and adjust the treatment plan as needed 3, 5.
CIWA Score in Treatment Decisions
- The CIWA-Ar score can be used to guide the use of benzodiazepines in patients with AWS, with higher scores indicating a greater need for medication 2, 3.
- The score can also be used to compare the effectiveness of different treatments, such as benzodiazepines and non-benzodiazepines, in managing AWS 3, 6.
- A symptom-triggered benzodiazepine protocol utilizing CIWA-Ar scoring can be effective in reducing the duration of AWS treatment and benzodiazepine exposure 5.
Limitations and Variations
- The CIWA-Ar score may not be suitable for patients who are unable to communicate or have significant cognitive impairment 4.
- Different studies have used varying thresholds for the CIWA-Ar score to guide treatment decisions, and the optimal threshold may depend on the specific patient population and treatment setting 2, 3, 4.