CIWA-Ar (alcohol withdrawal)
CIWA-Ar (alcohol withdrawal) - a deterministic tool in Sophie Well's Clinical Scoring & Risk group.
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What this is
Score the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar, Sullivan 1989) across its ten items - nausea, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances, headache, and orientation. Sophie Well sums to a 0-67 total and returns the conventional severity band so the bedside nurse and prescriber can drive a symptom-triggered protocol.
When to use it
Use this at scheduled intervals (typically q1-2h) for an inpatient at risk of alcohol withdrawal so benzodiazepine dosing can be triggered by score thresholds rather than fixed schedules. CIWA assumes the patient can communicate; for intubated, sedated, or non-verbal patients, an observation-only scale such as the Minnesota Detoxification Scale (MINDS) or RASS-driven protocol is more appropriate.
References
Sullivan JT, et al. Assessment of alcohol withdrawal: the revised CIWA-Ar. Br J Addict. 1989;84(11):1353-1357.
Worked example: CIWA-Ar 10 (moderate withdrawal, 8-15 band; symptom-triggered protocol typically considers active treatment).
Sophie Well is a reference and educational tool. Not medical, legal, or financial advice. Does not replace clinician judgment, professional billing review, or legal counsel.