Clinical Institute Withdrawal Assessment

The CIWA (Clinical Institute Withdrawal Assessment)  is a common measure used in North American hospitals to assess and treat Alcohol withdrawal syndrome and for Alcohol detoxification. This clinical tool assesses 10 common withdrawal signs. A score of more than 15 points is associated with increased risk of alcohol withdrawal effects such as confusion or seizures.

Scoring
The cumulative score provides the basis for treatment of patients undergoing alcohol withdrawal.

Nausea and Vomiting
Ask: "Do you feel sick to your stomach? Have you vomited?"

Tremor
Arms extended and fingers spread apart

Anxiety
Ask: "Do you feel nervous?"

Tactile Disturbances
Ask: "Have you any itching, pins and needles sensations, burning sensations, numbness or do you feel bugs crawling on or under your skin?"

Auditory Disturbances
Ask: "Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?"

Visual Disturbances
Ask: "Does the light appear to be too bright? Is its colour different? Does it hurt your eyes? Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?"

Headache, Fullness in Head
Ask: "Does your head feel different? Does it feel as if there is a band around your head?" Do not rate for dizziness or lightheadedness. Otherwise, rate severity.

Orientation and Clouding of Sensorium
Ask: "What day is this? Where are you? Who am I?"