Psychometric analysis of subjective sedation scales used for critically ill paediatric patients

Abstract

Aims: This study evaluated the psychometric properties of subjective sedation scales using one psychometric scoring system to identify the appropriate scale that is most suitable for clinical care practice. Background: A number of published sedation assessment scales for paediatric patients are currently used to attempt to achieve a moderate depth of sedation to avoid the undesirable effects caused by over-or undersedation. However, there has been no systematic review of these scales. Search strategy: We searched the Cochrane Library, PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, etc., to obtain relevant articles. The quality of the selected studies was evaluated according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Inclusion criteria: Articles that had been published or were in press and discussed the psychometric properties of sedation scales were included. The population comprised critically ill infants and non-verbal children ranging in age from 0 to 18 years who underwent sedation in an intensive care unit. Findings: Data were independently extracted by two investigators using a standard data extraction checklist: 43 articles were included in this review, and 13 sedation scales were examined. The quality of the psychometric evidence for the Comfort Scale and Comfort Behaviour Scale was 'very good', with the Comfort Scale having a higher quality (total weighted scores, Comfort Scale = 17⋅3 and Comfort Behaviour Scale = 15⋅5). Conclusions: We suggest that the scales be systematically and comprehensively tested in terms of development method, reliability, validation, feasibility and correlation with clinical outcome. The Comfort Scale and Comfort Behaviour Scale are useful tools for measuring sedation in paediatric patients. Relevance to clinical practice: Nursing staff should choose one subjective sedation scale that is suitable for assessing paediatric patients' depth of sedation. We recommend the Comfort Scale and Comfort Behaviour Scale as optimal choices if the clinical environment permits.

The sedation practices of paediatric intensive care unit nurses and the influencing factors in China

“…). As the intubated children cannot express themselves, especially when in a critical condition or when administered a neuromuscular blockade agent, the nurses must resort to observing the physiological and behavioural responses (Chanques et al ., ; Dijk et al ., ), which have been supported by several systematic reviews (Dorfman et al ., ; Ge et al ., ; Grap et al ., ) focusing on the instruments for scoring sedation cues to pain and distress. In 2016, the ESPNIC published a position statement regarding the clinical recommendations for sedation, which suggested some validated tool for intubated children in PICUs.…”

Validation of the Ramsay scale for invasive procedures under deep sedation in pediatrics

“…A recent systematic review showed many gaps in the original validation of the RS and that its psychometric properties were poor for children. 9 Despite including patients ≥8 years, the original RS article does not include information on interrater and intrarater reliability, construct validity, criterion validity, or applicability for children. This, coupled with the fact that there are no subsequent validation studies in pediatrics, make their psychometric properties poor in this population.…”

“…A recent systematic review showed many gaps in the original validation of the scale and that its psychometric properties were poor for children. 9 The scale uses auditory and tactile stimuli to measure sedation at deep levels, which interferes with the procedure (mainly procedures with immobility) and increases the probability of subjectivity. It cannot be used on relaxed patients or on those that are agitated, given that agitation is only described in level one.…”

“…This scale also has its limitations 8 ; mainly that it has not been formally validated for children. A recent systematic review showed many gaps in the original validation of the scale and that its psychometric properties were poor for children 9 . The scale uses auditory and tactile stimuli to measure sedation at deep levels, which interferes with the procedure (mainly procedures with immobility) and increases the probability of subjectivity.…”

What's in this Issue

“…Several sedation scales have been developed to assist clinicians in achieving this delicate balance, but which instrument to choose may not always be so clear. This led Ge et al (2018) to conduct a systematic review of all articles evaluating the psychometric properties of sedation scales among children and adolescents. Forty-three papers examining 13 sedation scales were retrieved and appraised using Robinson et al's (2013) scoring system, which was re-evaluated by a team of experts through a structured Dephi method.…”