Comparison of CIWA-Ar and MINDS Alcohol Withdrawal Assessments in Hospitalized Patients

Abstract Background The revised Clinical Institute Withdrawal Assessment (CIWA-Ar) and the Minnesota Detoxification Scale (MINDS) are two scales used to assess alcohol withdrawal symptom severity among hospitalized patients. There is a lack of data supporting the reliability of these scales in acutely ill patients. Objective The objective of this study was to measure the reliability of CIWA-Ar and modified MINDS (mMINDS) and the correlation of the two scales to each other. Methods A prospective, observational study was conducted to evaluate adult patients with an alcohol withdrawal order set within 48 hr of hospital admission at two community hospitals. During nursing hand-off, the outgoing and incoming nurse both completed a CIWA-Ar and mMINDS assessment consecutively and independently. Correlations between CIWA-Ar, mMINDS, and the two observers were calculated. Results A total of 114 hand-off observations were collected for 73 patients. The frequency of an “unable to assess” item resulting in an invalid total score was 34.2% with CIWA-Ar and 28.9% with mMINDS. The median scores for CIWA-Ar and mMINDS were both 6 (IQR 3 to 10) and correlated well to each other (r = .801). Correlations between the two nurse raters was moderate for both CIWA-Ar (r = .68) and mMINDS (r = .72). As withdrawal scores increased, the difference in score between nursing raters also increased for both instruments. Conclusion CIWA-Ar and mMINDS are moderately correlated to each other and produce similar total scores. Correlations between two nursing raters suggest similar performance in rater agreement for both instruments; however, performance diminished as withdrawal severity increased.