The Clinical Institute Withdrawal Assessment for Alcohol, commonly abbreviated as CIWA or CIWA-Ar (revised version), is a 10-item scale used in the assessment and management of

alcohol withdrawal Alcohol withdrawal syndrome (AWS) is a set of symptoms that can occur following a reduction in alcohol use after a period of excessive use. Symptoms typically include anxiety, shakiness, sweating, vomiting, fast heart rate, and a mild fever. M ...

. Each item on the scale is scored independently, and the summation of the scores yields an aggregate value that correlates to the severity of alcohol withdrawal, with ranges of scores designed to prompt specific management decisions such as the administration of

benzodiazepines Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, i ...

. The maximum score is 67; Mild alcohol withdrawal is defined with a score less than or equal to 10, moderate with scores 11 to 15, and severe with any score equal to or greater than 16.

CIWA-Ar

The CIWA-Ar is actually a shortened, improved version of the CIWA, geared towards objectifying alcohol withdrawal symptom severity. It retains validity, usefulness and reliability between raters. This revised version is the most commonly used scale in alcohol withdrawal, and was developed at the Addiction Research Foundation (now

Centre for Addiction and Mental Health The Centre for Addiction and Mental Health (CAMH, pronounced , french: Centre de toxicomanie et de santé mentale) is a psychiatric teaching hospital located in Toronto and ten community locations throughout the province of Ontario, Canada. It re ...

Scale

The ten items evaluated on the scale are common symptoms and signs of alcohol withdrawal, and are as follows: *

Nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

and vomiting *Tremor *

Paroxysmal Paroxysmal attacks or paroxysms (from Greek παροξυσμός) are a sudden recurrence or intensification of symptoms, such as a spasm or seizure. These short, frequent symptoms can be observed in various clinical conditions. They are usually ...

sweats *Anxiety *Agitation *

Tactile Tactile may refer to: * Tactile, related to the sense of touch * Haptics (disambiguation) * Tactile (device), a text-to-braille translation device See also * Tangibility, in law * Somatosensory system, where sensations are processed * CD96 CD9 ...

disturbances * Auditory disturbances *

Visual disturbances A vision disorder is an impairment of the sense of vision. Vision disorder is not the same as an eye disease. Although many vision disorders do have their immediate cause in the eye, there are many other causes that may occur at other locations in ...

Headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...

*Orientation and clouded

sensorium A sensorium (/sɛnˈsɔːrɪəm/) (plural: sensoria) is the apparatus of an organism's perception considered as a whole, the "seat of sensation" where it experiences, perceives and interprets the environments within which it lives. The term origi ...

Scoring

All items are scored from 0–7, with the exception of the orientation category, scored from 0–4. The CIWA scale is validated and has high inter-rater reliability. A randomized,

double blind In a blind or blinded experiment, information which may influence the participants of the experiment is withheld until after the experiment is complete. Good blinding can reduce or eliminate experimental biases that arise from a participants' expec ...

trial published in ''

JAMA ''The Journal of the American Medical Association'' (''JAMA'') is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of biom ...

'' in 1994Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994;272:519-23. showed that management for alcohol withdrawal that was guided by the CIWA scale resulted in decreased treatment duration and total use of

. The goal of the CIWA scale is to provide an efficient and objective means of assessing alcohol withdrawal. Studies have shown that use of the scale in management of alcohol withdrawal leads to decreased frequency of over-sedation with benzodiazepines in patients with milder alcohol withdrawal than would otherwise be detected without use of the scale, and decreased frequency of under-treatment in patients with greater severity of withdrawal than would otherwise be determined without the scale.

References

External links

CIWA Score for Alcohol Withdrawal
format
CIWA Score for Alcohol Withdrawal
{{Webarchive, url=https://web.archive.org/web/20150923135645/http://www.mdcalc.com/ciwa-ar-for-alcohol-withdrawal/ , date=2015-09-23 online calculator
Alcohol Addiction
in India
Alcohol Addiction
in India
The Essential Handbook of Treatment and Prevention of Alcohol Problems
Alcohol and health Alcohol abuse screening and assessment tools