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Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children
Erwin Ista1, Monique van Dijk, Matthijs de Hoog
1Intensive Care Unit, Department of Pediatrics, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands. w.ista@erasmusmc.nl
Insights
This study developed a new tool to monitor opioid and benzodiazepine withdrawal in pediatric ICU patients. The instrument identifies key symptoms based on expert opinion and data analysis.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Clinical Assessment Tools
Background:
- Opioid and benzodiazepine withdrawal is a significant concern in pediatric intensive care units (PICUs).
- Existing assessment tools may not be specifically tailored for pediatric populations or capture the nuances of drug withdrawal in critically ill children.
- Reliable monitoring is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To develop a reliable and clinically practical instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric ICU patients.
- To create an assessment tool grounded in empirical data and expert consensus.
Main Methods:
- Instrument development involved an expert panel of 85 physicians and nurses.
- 79 pediatric patients (up to 16 years) on intravenous midazolam and/or opioids for at least 5 days were included.
- A checklist of 24 withdrawal symptoms was used, with observations performed during drug weaning. Multidimensional scaling (MDS) analyzed symptom co-occurrences.
Main Results:
- 932 observations were obtained from 76 children within 24 hours of drug reduction or discontinuation.
- Frequent symptoms included tachypnea, agitation, motor disturbance, diarrhea, fever, anxiety, sleep disturbance, and hypertension.
- An expert panel identified agitation, anxiety, inconsolable crying, increased muscle tension, tremors, tachycardia, and sweating as highly relevant symptoms. 15 symptoms were included in the final instrument based on MDS and expert input.
Conclusions:
- This study presents the first assessment tool for pediatric ICU withdrawal symptoms based on empirical symptom co-occurrence structures and expert relevance.
- The developed instrument offers a clinically practical approach to monitoring withdrawal in this vulnerable patient group.
- Future research should focus on defining psychometric properties and establishing cut-off points for the instrument.
Objective:
To construct a reliable and clinically practical instrument for monitoring opioids and benzodiazepine withdrawal symptoms in pediatric ICU patients.
Design:
Instrument development.
Setting:
Intensive care unit in an academic children's hospital.
Patients And Participants:
79 patients up to age 16 years on intravenous midazolam and/or opioids for > or =5 days. An expert panel of 85 physicians and nurses rated clinical relevance of withdrawal symptoms.
Intervention:
During drug weaning repeated observations were performed with a checklist of 24 withdrawal symptoms described in the literature.
Measurements And Results:
For 76 children, 932 observations were obtained within 24 h after decrease and/or discontinuation of midazolam or opioids. Most frequent symptoms were tachypnea, agitation, motor disturbance, diarrhea, fever, anxiety, sleep disturbance and hypertension (14.6-29.6%). Multidimensional scaling (MDS) was performed to detect the underlying empirical structure of co-occurrences of symptoms. An expert panel judged clinical relevance of each withdrawal symptom on a four-point scale ranging from 'definitively so' to 'definitively not'. Agitation, anxiety, inconsolable crying, increased muscle tension, tremors, tachycardia and sweating were considered relevant by 85-95% of the experts. On the basis of the MDS results and the experts' opinions, 15 symptoms were included in the final instrument.
Conclusions:
We are the first to develop an assessment tool for withdrawal symptoms in pediatric ICU patients on the basis of the underlying empirical structure of co-occurrences of withdrawal symptoms that experts considered relevant. Future studies need to define cut-off points and clarify psychometric issues.
