小儿麻醉苏醒期谵妄量表的编制与心理测量学评估
Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale.
作者信息
Sikich Nancy, Lerman Jerrold
机构信息
St. Michael's Hospital, Department of Anesthesia, 30 Bond Street, Toronto, Ontario, Canada.
出版信息
Anesthesiology. 2004 May;100(5):1138-45. doi: 10.1097/00000542-200405000-00015.
BACKGROUND
Emergence delirium has been investigated in several clinical trials. However, no reliable and valid rating scale exists to measure this phenomenon in children. Therefore, the authors developed and evaluated the Pediatric Anesthesia Emergence Delirium (PAED) scale to measure emergence delirium in children.
METHODS
A list of scale items that were statements describing the emergence behavior of children was compiled, and the items were evaluated for content validity and statistical significance. Items that satisfied these evaluations comprised the PAED scale. Each item was scored from 1 to 4 (with reverse scoring where applicable), and the scores were summed to obtain a total scale score. The degree of emergence delirium varied directly with the total score. Fifty children were enrolled to determine the reliability and validity of the PAED scale. Scale validity was evaluated using five hypotheses: The PAED scale scores correlated negatively with age and time to awakening and positively with clinical judgment scores and Post Hospital Behavior Questionnaire scores, and were greater after sevoflurane than after halothane. The sensitivity of the scale was also determined.
RESULTS
Five of 27 items that satisfied the content validity and statistical analysis became the PAED scale: (1) The child makes eye contact with the caregiver, (2) the child's actions are purposeful, (3) the child is aware of his/her surroundings, (4) the child is restless, and (5) the child is inconsolable. The internal consistency of the PAED scale was 0.89, and the reliability was 0.84 (95% confidence interval, 0.76-0.90). Three hypotheses supported the validity of the scale: The scores correlated negatively with age (r = -0.31, P <0.04) and time to awakening (r = -0.5, P <0.001) and were greater after sevoflurane anesthesia than halothane (P <0.008). The sensitivity was 0.64.
CONCLUSIONS
These results support the reliability and validity of the PAED scale.
背景
多项临床试验对苏醒期谵妄进行了研究。然而，目前尚无可靠且有效的评定量表来衡量儿童的这一现象。因此，作者开发并评估了小儿麻醉苏醒期谵妄（PAED）量表，以测定儿童的苏醒期谵妄。
方法
编制了一份量表条目清单，这些条目均为描述儿童苏醒行为的陈述语句，并对这些条目进行内容效度和统计学意义评估。符合这些评估的条目构成了PAED量表。每个条目从1至4分进行评分（适用时进行反向计分），将各条目得分相加得出量表总分。苏醒期谵妄程度与总分直接相关。纳入50名儿童以确定PAED量表的信度和效度。使用五个假设评估量表效度：PAED量表得分与年龄和苏醒时间呈负相关，与临床判断评分和出院后行为问卷评分呈正相关，且七氟醚麻醉后的得分高于氟烷麻醉后的得分。同时还确定了量表的敏感性。
结果
满足内容效度和统计分析的27个条目中有5个成为PAED量表：（1）患儿与照料者有目光接触；（2）患儿的行为有目的性；（3）患儿知晓周围环境；（4）患儿烦躁不安；（5）患儿无法安抚。PAED量表的内部一致性为0.89，信度为0.84（95%置信区间，0.76 - 0.90）。三个假设支持了量表的效度：得分与年龄呈负相关（r = -0.31，P <0.04）、与苏醒时间呈负相关（r = -0.5，P <0.001），且七氟醚麻醉后的得分高于氟烷麻醉后的得分（P <0.008）。敏感性为0.64。
结论
这些结果支持了PAED量表的信度和效度。
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