Alcohol Withdrawal Assessment Scoring Guidelines (CIWA - Ar) 2026

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The document outlines the Alcohol Withdrawal Assessment Scoring Guidelines using the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) scale. It provides detailed criteria for assessing symptoms of alcohol withdrawal, including nausea/vomiting, tremors, anxiety, agitation, paroxysmal sweats, orientation, tactile disturbances, auditory and visual disturbances, and headache. Each symptom is rated on a specific scale to determine the severity of withdrawal. The guidelines emphasize the importance of early intervention based on total CIWA-Ar scores to prevent progression of withdrawal symptoms.

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Click ‘Get Form’ to open the Alcohol Withdrawal Assessment Scoring Guidelines (CIWA - Ar) in the editor.
Begin by entering patient details at the top of the form, including name, hospital number, and date of birth.
Assess each of the ten criteria listed on the CIWA scale. For each criterion, rate the severity on a scale from 0 to 7, except for 'Orientation and clouding of sensorium,' which is rated from 0 to 4.
Carefully document your observations for each criterion. Ensure that you provide accurate ratings based on patient responses and behaviors.
Calculate the total CIWA-Ar score by adding up all individual scores. This score will guide further treatment decisions.
If necessary, document any PRN medication administration and assess the patient's response after 30-60 minutes.

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How is the CIWA-Ar assessment scored?

Scores of less than 8 to 10 indicate minimal to mild withdrawal. Scores of 8 to 15 indicate moderate withdrawal (marked autonomic arousal); and scores of 15 or more indicate severe withdrawal (impending delirium tremens). The assessment requires 2 minutes to perform (Sullivan, et al, 1989).

What is a CIWA score of 21?

21 points or higher: Severe alcohol withdrawal may be present.

What CIWA score indicates medication?

Add up the scores for all ten criteria. This is the total CIWA-Ar score for the patient at that time. Prophylactic medication should be started for any patient with a total CIWA-Ar score of 8 or greater (ie.

What is the CIWA score for anxiety?

Table 1The ten alcohol withdrawal symptoms of CIWA-Ar and range of scoring scale Nausea or vomiting (0-7)Tactile disturbances (0-7) Anxiety (0-7) Headache (0-7) Agitation (0-7) Orientation and clouding of sensorium (0-4) Total score is the total sum of each item score (maximum score is 67).2 more rows

What does a CIWA score of 20 mean?

The CIWA-Ar scale can measure 10 symptoms. Scores of less than 8 to 10 indicate minimal to mild withdrawal. Scores of 8 to 15 indicate moderate withdrawal (marked autonomic arousal); and scores of 15 or more indicate severe withdrawal (impending delirium tremens).

What is the withdrawal score scale?

Score: 5- 1 2 = mild; 1 3-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal This version may be copied and used clinically. Source: Wesson, D. R., Ling, W. (2003).

What CIWA score needs ICU?

What are the orders entered by Dr. West for a CIWA score of 21? Lorazepam 2 mg IV as needed every hour until score is 8. Then Lorazepam 1 mg IV every 6 hours as a scheduled dose.