儿科重症监护中的COMFORT行为量表和改良的FLACC量表。

The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care.

作者信息

Johansson Monica, Kokinsky Eva

机构信息

Paediatric Intensive Care Unit, Queen Silvia Children's Hospital, Göteborg, Sweden.

出版信息

Nurs Crit Care. 2009 May-Jun;14(3):122-30. doi: 10.1111/j.1478-5153.2009.00323.x.

DOI:10.1111/j.1478-5153.2009.00323.x

PMID:19366409

Abstract

AIMS AND OBJECTIVES

To evaluate the concurrent validity and reliability of the behavioural COMFORT and a modified version of the FLACC scale for assessment of pain and sedation in intubated and ventilated children and to evaluate the construct validity of the FLACC scale for assessment of pain.

BACKGROUND

Few instruments are available for assessment of pain/sedation in paediatric intensive care.

DESIGN

A prospective observational study was performed postoperatively in 40 children aged 0-10 years.

METHODS

Two trained nurses observed the child simultaneously and assessing COMFORT behavioural (COMFORT-B) and FLACC scores. In comparison, two bedside nurses concurrently scored pain using an observational visual analogue scale (VAS(obs)) and sedation using the Nurse Interpretation of Sedation (NIS) score: oversedated, adequately or insufficient sedated. In 20 additional patients, one nurse assessed FLACC scores before and after analgesics.

RESULTS

The majority of patients were <1 year. A moderate but significant correlation was found between each scale and both sedation and VAS(obs). COMFORT-B differentiated better than FLACC between the three sedation levels. For those assessed to be in pain (VAS(obs) > 3), both COMFORT-B and FLACC scores were significantly different compared with VAS(obs) < 3. The interrater reliability was high for COMFORT-B and FLACC (kappa 0.71 and 0.63, respectively). For bedside nurses' assessment of pain, the interrater reliability was high (kappa 0.63) but low for the level of sedation (kappa 0.20). After administration of analgesics, the FLACC median score decreased significantly from 5 to 0.

CONCLUSIONS

The COMFORT-B scale was a more reliable measure of children's sedation than bedside subjective assessment and gives more substantial information about sedation than the FLACC scale. Concurrent validity for assessment of pain was supported for both scales. The modified FLACC showed construct validity for measuring pain.

RELEVANCE TO CLINICAL PRACTICE

The use of validated scales may improve the assessment and management of pain and sedation in intubated children.

摘要

目的与目标

评估行为舒适量表（COMFORT）以及改良版面部表情、腿部活动、活动、哭闹、可安慰性量表（FLACC）在评估插管及机械通气儿童疼痛和镇静方面的同时效度与信度，并评估FLACC量表在疼痛评估方面的结构效度。

背景

儿科重症监护中用于评估疼痛/镇静的工具较少。

设计

对40名0至10岁儿童进行术后前瞻性观察研究。

方法

两名经过培训的护士同时观察患儿，评估舒适行为量表（COMFORT-B）和FLACC评分。作为对照，两名床边护士同时使用观察视觉模拟量表（VAS(obs)）评估疼痛，并使用护士镇静评估量表（NIS）评估镇静情况：镇静过度、镇静适当或镇静不足。另外对20名患者，由一名护士在给予镇痛药前后评估FLACC评分。

结果

大多数患者年龄小于1岁。各量表与镇静及VAS(obs)之间均存在中度但显著的相关性。在三种镇静水平下，COMFORT-B量表比FLACC量表区分度更好。对于评估为疼痛（VAS(obs)>3）的患者，COMFORT-B量表和FLACC量表评分与VAS(obs)<3的患者相比均有显著差异。COMFORT-B量表和FLACC量表的评分者间信度较高（kappa分别为0.71和0.63）。对于床边护士的疼痛评估，评分者间信度较高（kappa为0.63），但镇静水平评估的评分者间信度较低（kappa为0.20）。给予镇痛药后，FLACC中位数评分从5显著降至0。