Clinical Institute Withdrawal Assessment for Alcohol—Revised (CIWA-Ar)
The most objective tool to assess the severity of alcohol withdrawal is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar). Score consists of 10 items and can be performed in 5 minutes at the bedside. The questions include regarding following 10 items
- nausea and vomiting,
- anxiety,
- tremor,
- sweating,
- auditory disturbances,
- visual disturbances,
- tactile disturbances,
- headache,
- agitation,
- clouding of sensorium
0 to 7 points are assigned for each item except for the last item, which is assigned 0-4 points, with a total possible score of 67.
The CIWA-Ar is not copyrighted and may be reproduced freely. Patients scoring less than 10 do not usually need additional medication for withdrawal.
CIWA-Ar has been demonstrated to have high reliability, reproducibility, and validity. Careful and frequent monitoring with the CIWA-Ar is clinically found to be very helpful.
You can view the full survey here (pdf)
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