Assessment of alcohol withdrawal in native American patients utilizing the Clinical Institute Withdrawal Assessment of Alcohol Revised scale

Douglas Rappaport, Andy Chuu, Craig Hullett, Saman Nematollahi, Mary Teeple, Natasha Bhuyan, Iiro Honkanen, William Joaquin Adamas-Rappaport, Arthur Sanders

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: The Clinical Institute Withdrawal Assessment of Alcohol Revised (CIWA-Ar) is a commonly used scale for assessing the severity of alcohol withdrawal syndrome in the acute setting. Despite validation of this scale in the general population, the effect of ethnicity on CIWA-Ar scoring does not appear in the literature. The purpose of our study was to investigate the validity of the CIWA-Ar scale among Native American patients evaluated for acute alcohol detoxification. Methods: A case series of all patients seen for alcohol withdrawal at an Acute Drug and Alcohol Detoxification facility was conducted from June 1, 2011, until April 1, 2012. The CIWA-Ar scores were recorded by trained nursing staff on presentation to Triage Department and every 2 hours thereafter. At our institution, a score of 10 or greater indicates the need for inpatient hospital admission and treatment. Ethnicity was self-reported. Age, sex, blood alcohol concentration, blood pressure, and pulse were recorded on presentation and vital signs repeated every 2 hours. Patients were excluded from the study if other drug use was noted by history or initial urine drug screen. A multivariate logistic regression model was utilized to identify statistically significant variables associated with admission to the inpatient unit and treatment. The relationship of CIWA-Ar scores and ethnicity was compared using analysis of variance. Results: A total of 115 whites, 45 Hispanics, and 47 Native Americans were included in the analysis. Native Americans had consistently lower CIWA-Ar scores at 0, 2, 4, and 6 hours than the other 2 ethnic groups (P = 0.002). In addition, Native Americans were admitted to the hospital less often than the other 2 groups for withdrawal (P < 0.001). Conclusions: The CIWA-Ar scale may underestimate the severity of alcohol withdrawal syndrome in certain ethnic group such as Native Americans. Further prospective studies should be undertaken to determine the validity of the CIWA-Ar scale in assessing alcohol withdrawal across different ethnic populations.

Original languageEnglish (US)
Pages (from-to)196-199
Number of pages4
JournalJournal of addiction medicine
Volume7
Issue number3
DOIs
StatePublished - May 1 2013

Keywords

  • Alcohol withdrawal assessment
  • CIWA-Ar
  • Ethnicity

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

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