CIWA-Ar
Objectifies alcohol withdrawal severity for symptom-triggered treatment
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Care settings
- Emergency department, ICU, Inpatient
When it activates
Scribeable activates a calculator from the encounter. The CIWA-Ar can activate when the transcript or pasted chart context documents any of these:
- Alcohol withdrawal
- Benzodiazepine dosing for withdrawal
- Delirium tremens risk
- Inpatient detoxification
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: F10.23.
Note-type scope: it activates on notes whose subject resolves to psychiatry, emergency medicine, hospital medicine, critical care. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
10 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Nausea/vomiting | symptom | ||
| Tremor | exam | ||
| Paroxysmal sweats | exam | ||
| Anxiety | symptom | ||
| Agitation | exam | ||
| Tactile disturbances | symptom | ||
| Auditory disturbances | symptom | ||
| Visual disturbances | symptom | ||
| Headache | symptom | ||
| Orientation | exam |
Scoring
10 items, most 0-7 each, orientation 0-4. Max 67.
Sum of 10 symptom scales: nausea Nausea/vomiting + tremor Tremor + sweats Paroxysmal sweats + anxiety Anxiety + agitation Agitation + tactile Tactile disturbances + auditory Auditory disturbances + visual Visual disturbances + headache Headache + orientation Orientation
Interpretation
<=8: Minimal, monitor. 9-19: Mild-moderate, PRN benzos. >=20: Severe, may need ICU.
Evidence
Sources carried in Scribeable's citation registry for this calculator.
- Sullivan JT et al. Assessment of alcohol withdrawal: the revised CIWA scale (CIWA-Ar)Sullivan et al. (CIWA-Ar) 1989 · 1989 · link last verified 2026-03-23
How Scribeable handles it in the note
When an encounter activates the CIWA-Ar at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated CIWA-Ar value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
See it activate on your own encounter
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