Psychometric evaluation of the Sophia Observation withdrawal symptoms scale in critically ill children
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Published on: December 2, 2015
Erwin Ista1, Matthijs de Hoog, Dick Tibboel
1All authors: Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
The Sophia Observation withdrawal Symptoms scale effectively screens for benzodiazepine and opioid withdrawal in pediatric intensive care unit (PICU) patients, demonstrating good sensitivity and specificity. This validated tool aids in managing withdrawal syndrome in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Psychometrics
Background:
- Benzodiazepine and opioid withdrawal syndrome (BWO/OWS) is a significant concern in pediatric critical care patients.
- Accurate and reliable screening tools are essential for timely diagnosis and management of withdrawal symptoms.
- The Sophia Observation withdrawal Symptoms scale (SOSs) was developed to address this need in the pediatric intensive care unit (PICU) population.
Purpose of the Study:
- To establish cutoff scores for the Sophia Observation withdrawal Symptoms scale (SOSs) for screening benzodiazepine and opioid withdrawal syndrome.
- To evaluate the sensitivity to change of the SOSs in pediatric critical care patients.
- To identify risk factors associated with the development of withdrawal syndrome in this population.
Main Methods:
- Prospective observational study utilizing repeated measures in a Level IV university children's hospital ICU.
- 154 pediatric patients (median age 5 months) receiving continuous benzodiazepine and/or opioid infusions for ≥5 days were included.
- The Sophia Observation withdrawal Symptoms scale (SOSs) and Numeric Rating Scale (NRS) withdrawal scores were applied repeatedly during weaning.
Main Results:
- 3,754 paired assessments were analyzed; the SOSs demonstrated a sensitivity of 0.83 and specificity of 0.93 for a cutoff score of ≥4 compared to NRS-withdrawal.
- The SOSs showed significant sensitivity to change, with a mean decline of 1.5 points after intervention (p < 0.0001).
- Logistic regression identified duration of midazolam/morphine infusion and weaning, and the number of additional sedatives/opioids as significant risk factors for withdrawal.
Conclusions:
- The Sophia Observation withdrawal Symptoms scale (SOSs) is a valid and reliable instrument for assessing withdrawal symptoms in pediatric intensive care unit (PICU) patients.
- The established cutoff scores and demonstrated sensitivity to change support its clinical utility.
- Identifying specific risk factors aids in proactive management and prevention of withdrawal syndrome in critically ill children.
Objective:
The Sophia Observation withdrawal Symptoms scale is an instrument for screening benzodiazepine and opioid withdrawal syndrome in pediatric critical care patients. The objectives of this study were to establish cutoff scores and to test sensitivity to change. Second, risk factors for withdrawal syndrome were explored.
Design:
Prospective observational study with repeated measures.
Setting:
Level IV ICU at a university children's hospital.
Patients:
A total of 154 children with median age 5 months (interquartile range, 0-42 mo) who received continuous infusion of benzodiazepines and/or opioids for 5 or more days.
Interventions:
None.
Measurements And Main Results:
Nurses repeatedly applied the Sophia Observation withdrawal Symptoms scale and the Numeric Rating Scale withdrawal when children were weaned off benzodiazepines and opioids. The latter represents the nurse's expert opinion. We analyzed 3,754 paired assessments; the median number per child was 15 (interquartile range, 7-31) over a median of 5 days (interquartile range, 3-11 d). Sensitivity and specificity were 0.83 and 0.93, respectively, for the Sophia Observation withdrawal Symptoms scale cutoff score of 4 or higher against a Numeric Rating Scale-withdrawal score of 4 or higher. Sensitivity to change was determined by comparing 156 Sophia Observation withdrawal Symptoms scale assessments (n = 51 patients) before and after additional sedatives or opioids. Multilevel regression analysis showed a mean decline of 1.5 points (at score range 0-15) after intervention (p < 0.0001). Logistic regression analysis identified duration of preweaning of midazolam, duration of weaning of midazolam, duration of preweaning of morphine, duration of weaning of morphine, and number of additional sedatives/opioids as statistically significant risk factors for withdrawal syndrome in these children.
Conclusions:
The Sophia Observation withdrawal Symptoms scale is a valid tool with good psychometric properties to assess withdrawal symptoms in PICU patients.
