What is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scale indicated in the assessment of delirium tremens (DTs)?

Updated: Nov 06, 2020
  • Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

The CIWA-Ar scale is intended only for patients who have been drinking recently. It relies on patients’ ability to respond to questions about their symptoms. Patients must be able to communicate and have a clear enough sensorium to reply logically, because many of the items require coherent answers. The CIWA-Ar scale has not been validated in complex medical patients, postsurgical patients, and critically ill patients. Therefore, the CIWA-Ar may not be applicable or reliable in critically ill patients, particularly in mechanically ventilated patients, as it relies on patient communication for information regarding nausea, vomiting, anxiety, tactile and auditory disturbances, and headache.

The CIWA-Ar has been revised for use in medical ICU patients, [6] but it has not been well studied or validated in this population.


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