接受计算机断层扫描的儿童的镇静深度：密歇根大学镇静量表（UMSS）的有效性和可靠性。

Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS).

作者信息

Malviya S, Voepel-Lewis T, Tait A R, Merkel S, Tremper K, Naughton N

机构信息

Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor 48109, USA.

出版信息

Br J Anaesth. 2002 Feb;88(2):241-5. doi: 10.1093/bja/88.2.241.

DOI:10.1093/bja/88.2.241

PMID:11878656

Abstract

BACKGROUND

Safe care of sedated children requires ongoing assessment of the depth of sedation to permit early recognition of progression to over-sedation. This study evaluated the validity and reliability of the University of Michigan Sedation Scale (UMSS) as a measure of sedation during procedures. The UMSS is a simple observational tool that assesses the level of alertness on a five-point scale ranging from 1 (wide awake) to 5 (unarousable with deep stimulation).

METHODS

Thirty-two children aged 4 months to 5 yr (mean 1.5 yr), sedated for computed tomography (CT), were studied prospectively. The CT nurse assessed sedation using the UMSS before sedative administration and every 10 min thereafter. The child was videotaped during each assessment, and segments were edited and their order was randomized. Four nurses blinded to sedative administration viewed the segments and scored sedation using the UMSS. One of these nurses also scored sedation using a visual analogue scale (VAS) and another using the Observer's Assessment of Alertness/Sedation Scale (OAAS). To examine the test-retest reliability, 75 randomly selected video segments were viewed and scored on a second occasion.

RESULTS

Changes in scores from baseline to discharge supported construct validity (P<0.0001). Criterion validity was demonstrated by significant correlations between the UMSS and the VAS and OAAS. There was good interobserver agreement between blinded observers' scores for each level of sedation and at discharge, and between blinded observers and the CT nurse for scores of 0 and 1 (lighter levels of sedation), but less agreement for scores 2 and 3 (deeper sedation) and discharge scores. Test-retest reliability was supported by agreement in the observers' UMSS scores.

CONCLUSION

The UMSS is a simple, valid and reliable tool that facilitates rapid and frequent assessment and documentation of depth of sedation in children.

摘要

背景

对接受镇静的儿童进行安全护理需要持续评估镇静深度，以便早期识别过度镇静的进展情况。本研究评估了密歇根大学镇静量表（UMSS）作为手术期间镇静程度衡量指标的有效性和可靠性。UMSS是一种简单的观察工具，通过五点量表评估警觉程度，范围从1（完全清醒）到5（深度刺激无反应）。

方法

前瞻性研究了32名年龄在4个月至5岁（平均1.5岁）、因计算机断层扫描（CT）接受镇静的儿童。CT护士在给予镇静剂前及之后每10分钟使用UMSS评估镇静情况。每次评估期间对儿童进行录像，对片段进行编辑并随机排列顺序。四名对镇静剂使用情况不知情的护士观看这些片段，并使用UMSS对镇静情况进行评分。其中一名护士还使用视觉模拟量表（VAS）对镇静情况进行评分，另一名护士使用观察者警觉性/镇静评估量表（OAAS）进行评分。为了检验重测信度，第二次观看并对75个随机选择的视频片段进行评分。

结果

从基线到出院时分数的变化支持了结构效度（P<0.0001）。UMSS与VAS和OAAS之间的显著相关性证明了效标效度。对于每个镇静水平以及出院时，不知情观察者的评分之间存在良好的观察者间一致性，对于评分0和1（较轻的镇静水平），不知情观察者与CT护士之间的一致性良好，但对于评分2和3（较深的镇静水平）以及出院评分，一致性较差。观察者UMSS评分的一致性支持了重测信度。