title: Assessment of alcohol withdrawal in Native American patients utilizing the Clinical Institute Withdrawal Assessment of Alcohol Revised Scale.
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.
authors.affiliation: University of Arizona College of Medicine, Tucson, AZ, USA. cd-jpk1@gmail.com
authors.forename: Douglas
authors.initials: D
authors.lastname: Rappaport
authors.forename: Andy
authors.initials: A
authors.lastname: Chuu
authors.forename: Craig
authors.initials: C
authors.lastname: Hullett
authors.forename: Saman
authors.initials: S
authors.lastname: Nematollahi
authors.forename: Mary
authors.initials: M
authors.lastname: Teeple
authors.forename: Natasha
authors.initials: N
authors.lastname: Bhuyan
authors.forename: Iiro
authors.initials: I
authors.lastname: Honkanen
authors.forename: William Joaquin
authors.initials: WJ
authors.lastname: Adamas-Rappaport
authors.forename: Arthur
authors.initials: A
authors.lastname: Sanders
mesh_terms: D000208:Acute Disease; D000328:Adult; D020268:Alcohol-Induced Disorders, Nervous System / Q000139:chemically induced / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D000431:Ethanol / Q000009:adverse effects / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006630:Hispanic or Latino / Q000523:psychology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology
chemical_list: D000431:Ethanol