TACTILE DISTURBANCES -- Ask "Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under. Alcohol Withdrawal Assessment Scoring Guidelines (CIWA - Ar). Nausea/ Vomiting - Rate on scale 0 - 7. Tremors - have patient extend arms & spread fingers. of Alcohol Scale, Revised (CIWA – Ar). Many qualification instruments have been developed for monitoring alcohol withdrawal. (Guthrie, ; Sullivan et al.

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PDF | A shortened item scale for clinical quantitation of the severity of the Assessment of Alcohol Withdrawal: The Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) Download full-text PDF. The Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) protocol (Figure 1) is the most common method of treating alcohol withdrawal in our institution and it is. Background: Alcohol withdrawal protocols involving symptom-triggered administration of Key words: alcohol withdrawal protocol; Clinical Institute Withdrawal.

Advanced Search Abstract — This paper reviews the literature on the use of rating scales within the treatment of the alcohol-withdrawal syndrome.


A computer-assisted literature search identified trials of therapy for and rating scales used in alcohol-withdrawal states.

Eighteen rating scales were identified. There is a wide variation in symptom items included in these scales. Scales also vary in their length and ease of application. We conclude that it is important to use validated and reliable assessment scales in research if proper comparisons of treatments for the alcohol-withdrawal syndrome are to be made.

Several different scales have been used within this field of research. Comparison difficulties are further exacerbated by the failure to use strict, comparable inclusion and exclusion criteria for study and control groups. An ideal rating scale in this area of research should: i aid the diagnosis of the withdrawal syndrome; ii indicate when drug therapy is required; iii alert staff to the development of serious withdrawal symptoms requiring more intensive medical input; iv reveal when medication can be discontinued and the patient safely discharged.

Such a tool would be useful in research and would facilitate comparisons between studies on existing and newer medications. Study groups could be compared both in terms of symptom presentation and severity.

Alcohol Withdrawal Syndrome

This would then allow treatment response to be accurately and consistently measured. In clinical practice, such a tool would allow clinicians to assess and predict those who require pharmacological treatment on the basis of symptom severity and to titrate the dose required. The aims of the present work were to identify rating scales used in the assessment of acute alcohol withdrawal described in the literature and then to compare their content and ease of application.

Information with regard to reliability and validity was also sought. METHODS A computer literature search and reference search of review articles traced papers published in the English language between and on pharmacological treatments of alcohol-withdrawal states.

The year was selected as the earliest date because it was the year Gross et al. Of the 38 papers reviewed, 23 described rating scales in sufficient detail for their content to be analysed.

Only those using a standardized system of scoring specific symptoms of withdrawal, and producing an overall measure of severity, were included. Four used a previously published scale so that, in total, 18 different scales were included.

This reveals the lack of consensus between existing scales as to which symptoms constitute the most significant indicators of the alcohol-withdrawal syndrome. No single symptom was included in all the scales analysed and scales differed in the numbers of items included.

A total of 30 symptoms and signs were described. Anxiety was included in most scales McGrath, ; Bjorkqvist et al.

Loss of co-ordination one scale: Bjorkqvist et al. Blood pressure, pulse and temperature were often measured as part of the overall assessment, but were included in only five scales Gross et al.

Scales 1—8 did not specify scoring criteria in the paper, whereas scales 9—16 did. Table 2 illustrates the wide variations in the weightings given to different symptom groups by the rating scales. Figures given are the percentage contribution of each group of symptoms to the total scale scores.

The seven groupings were those of affect, gastrointestinal GI disturbance, autonomic nervous system ANS disturbance, neurological disturbance, sleep, psychotic features and seizures. This comparison emphasizes the disparity in the weighting of items in the scales.

Reasons for the particular make-up of the scales concerned were not published in the original descriptions. Some of the scales appear to be biased towards the known actions of the drugs under investigation. For example the scale which gives the highest weighting to autonomic symptoms, such as hypertension and raised pulse rate Scale 11, Kraus et al. The scale that gave the highest weighting to seizures was used in investigating carbamazepine Agricola et al.

The most widely used scales, and those from which several other scales have been derived, are the Total Severity Assessment Gross et al. Both are well validated and will now be described in more detail.

Gross et al. These varied from those that simply recorded the presence or absence of symptoms, to those that rated severity. The scale contains 30 variables which are rated on an 8-point scale.

Zero indicates the absence of a symptom, whilst 7 indicates the maximum severity. The item scale was intended as a research tool and a shorter item scale, the SSA, was produced for clinical use.

Correlation coefficients were then calculated. Edward M. Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

This program to improve recognition and treatment of alcohol withdrawal was conducted because of a lack of validated diagnostic and clinical monitoring tools that could guide and improve treatment. Do you know of cases when it has been applied, interpreted, or used inappropriately?

There are some very good YouTube videos that are useful for training, such as this one.

Almost 30 years after we published this paper, I still get approached about its implementation. The most common misinterpretation of the CIWA-Ar Score is that it is a recipe for when to use pharmacologic treatment.

While scores of 10 or less rarely need pharmacologic treatment, clinical judgement is still very important with scores between Our typical management has been to use diazepam loading Sellers With training, nursing staff can readily and reliably perform scoring, but the score should not be used to drive "standing orders". Are there any adjustments or updates you would make to the score based on new data or practice changes?With training, nursing staff can readily and reliably perform scoring, but the score should not be used to drive "standing orders".

It can be easily and quickly administered by trained staff, making it suitable for use by nursing staff in the ward setting and in the community Bates, Can you give an example of a scenario in which you use it? Alcohol Clin Exp Resp. All items except for headache correspond to DSM-IV criteria for alcohol withdrawal and are rated at the time of the interview.

Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study. Study groups could be compared both in terms of symptom presentation and severity.