Translation and cross-cultural adaptation of the Pediatric Confusion Assessment Method for the Intensive Care Unit into Brazilian Portuguese for the detection of delirium in pediatric intensive care units

Abstract

ObjectiveTo undertake the translation and cross-cultural adaption into Brazilian Portuguese of the Pediatric Confusion Assessment Method for the Intensive Care Unit for the detection of delirium in pediatric intensive care units, including the algorithm and instructions.MethodsA universalist approach for the translation and cross-cultural adaptation of health measurement instruments was used. A group of pediatric critical care specialists assessed conceptual and item equivalences. Semantic equivalence was evaluated by means of a translation from English to Portuguese by two independent translators; reconciliation into a single version; back-translation by a native English speaker; and consensus among six experts with respect to language and content understanding by means of Likert scale responses and the Content Validity Index. Finally, operational equivalence was assessed by applying a pre-test to 30 patients.ResultsThe back-translation was approved by the original authors. The medians of the expert consensus responses varied between good and excellent, except for the feature "acute onset" of the instructions. Items with a low Content Validity Index for the features "acute onset" and "disorganized thinking" were adapted. In the pre-test, the expression "signal with your head" was modified into "nod your head" for better understanding. No further adjustments were necessary, resulting in the final version for Brazilian Portuguese.ConclusionThe Brazilian version of the Pediatric Confusion Assessment Method for the Intensive Care Unit was generated in agreement with the international recommendations and can be used in Brazil for the diagnosis of delirium in critically ill children 5 years of age or above and with no developmental cognitive disabilities.

Cross-cultural adaptation of the Richmond Agitation-Sedation Scale to Brazilian Portuguese for the evaluation of sedation in pediatric intensive care

“…In addition to being easy to use, it has been shown to have excellent interobserver reliability in adults admitted to clinical and surgical ICUs and excellent validity when compared to the VAS and other selected sedation scales (Glasgow Coma Scale, Ramsay and SAS). ( 23 , 27 ) It has been widely used not only to grade the level of sedation or agitation for monitoring and therapeutic adjustment but also as a prerequisite for the application of other instruments, such as the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) ( 44 ) and the Cornell Assessment of Pediatric Delirium, ( 45 ) both of which have been adapted for Brazilian Portuguese, ( 46 , 47 ) the Preschool Confusion Assessment Method for the ICU (psCAM-ICU) ( 48 ) and the Sophia Observation Withdrawal Symptoms scale-Pediatric Delirium scale (SOS-PD). ( 49 ) The RASS has undergone cross-cultural adaptation for other languages, such as Swedish, Spanish and Serbian.…”