Cravero Joseph P, Blike George T, Surgenor Stephen D, Jensen Jens
Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Anesth Analg. 2005 Jun;100(6):1614-1621. doi: 10.1213/01.ANE.0000150605.43251.84.
Studies of pediatric sedation practice have suffered from the lack of an objective scale that would allow for a comparison of the effectiveness and safety of sedation provided by various providers and techniques. We present the Dartmouth Operative Conditions Scale (DOCS), which is designed as a research tool to codify the appropriateness of the procedural conditions provided by various sedation interventions. To begin, human factors methodology was used to develop a model of the pediatric sedation process and to define the criteria for measuring a patient's condition during a procedure (DOCS). To accomplish validation, 70 video clips (30-s duration) were then selected from more than 300 h of procedural video tape for testing/grading purposes. Inter-rater reliability was tested by comparing the score for each video clip among 10 different raters. Intra-rater reliability was evaluated by retesting all of the raters 1 yr after their initial rating. Construct validity was confirmed by analyzing the change in DOCS score relative to the time that sedation intervention was undertaken. Criterion validity was tested by comparing the DOCS to a modified COMFORT score. The DOCS was completed with excellent inter-rater (kappa = 0.84) and intra-rater (kappa = 0.91) agreement by 10 health care providers with various backgrounds during the 1-yr study period. Criterion validity was supported by the close correlation between the DOCS and the modified COMFORT scores for 20 distinct video clips (Spearman correlation coefficient = 0.98; P <0.001). The distribution of DOCS scores 20 min after the anesthetic induction was significantly lower than the scores before initiation of sedation, and scores after emergence were consistently higher than those 20 min after sedation (P <0.001), thus confirming construct validity of the scale. The DOCS is a validated research tool when used with video data for comparing the effectiveness and safety of pediatric sedation service, regardless of technique used for decreasing anxiety or pain during a procedure.
儿科镇静实践的研究一直因缺乏客观量表而受到阻碍，该量表应能比较不同医疗服务提供者和技术所提供镇静的有效性和安全性。我们提出了达特茅斯手术条件量表（DOCS），它被设计为一种研究工具，用于编纂各种镇静干预措施所提供的手术条件的适宜性。首先，采用人因学方法来构建儿科镇静过程的模型，并定义在手术过程中衡量患者状况的标准（DOCS）。为完成验证，随后从300多个小时的手术录像带中选取了70个视频片段（时长30秒）用于测试/评分。通过比较10位不同评分者对每个视频片段的评分来测试评分者间信度。通过在初次评分1年后对所有评分者进行重新测试来评估评分者内信度。通过分析DOCS评分相对于进行镇静干预时间的变化来确认结构效度。通过将DOCS与改良的COMFORT评分进行比较来测试效标效度。在为期1年的研究期间，10名具有不同背景的医疗服务提供者对DOCS的评分者间一致性（kappa = 0.84）和评分者内一致性（kappa = 0.91）都非常出色。DOCS与20个不同视频片段的改良COMFORT评分之间的密切相关性支持了效标效度（斯皮尔曼相关系数 = 0.98；P <0.001）。麻醉诱导后20分钟的DOCS评分分布显著低于镇静开始前的评分，且苏醒后的评分始终高于镇静后20分钟的评分（P <0.001），从而证实了该量表的结构效度。无论在手术过程中使用何种技术来减轻焦虑或疼痛，当与视频数据一起使用时，DOCS都是一种经过验证的研究工具，可用于比较儿科镇静服务的有效性和安全性。
