To the Editor.
—In their meta-analysis, Dr Mayo-Smith and colleagues1 stated that alcohol withdrawal occurred in a wide variety of settings but did not comment on the appropriateness of their suggested guidelines for outpatients vs inpatients. The authors noted that the Clinical Institute Withdrawal Assessment, Alcohol (CIWA-A)2 and the CIWA-A, revised (CIWA-Ar)3 had been used for patients admitted to the hospital (detoxification units, psychiatry units, and general hospital medical/surgical wards), but they did not specify whether these structured assessment scales had been used or were applicable to outpatient settings. Three of the 10 questions on the CIWA-A scale pertain to tactile, auditory, and visual hallucinations,2 symptoms that often merit observation in inpatient rather than outpatient settings.4 Thus, these scales might be more applicable to inpatient settings.Symptom-triggered detoxification also might require modification for outpatients. In an outpatient setting, patients might not be assessed for symptoms of withdrawal as
Wiseman EJ. Pharmacologic Treatment of Alcohol Withdrawal. JAMA. 1997;278(16):1317-1318. doi:10.1001/jama.1997.03550160037027