Andersen Randi Dovland, Bernklev Tomm, Langius-Eklöf Ann, Nakstad Britt, Jylli Leena
Department of Child and Adolescent Health Services, Telemark Hospital, Skien, Norway.
Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
Acta Paediatr. 2015 Sep;104(9):904-9. doi: 10.1111/apa.13045. Epub 2015 Jun 22.
The COMFORT behavioural scale was developed to assess sedation, pain and distress in children unable to report pain. Our aims were to test construct validity of the scale in toddlers undergoing minor surgery and determine the inter-rater reliability of the scale.
We consecutively enrolled 45 children aged 12-36 months from a Norwegian surgical outpatient care unit. The level of sedation, pain and distress was assessed before and after surgery with the COMFORT behavioural scale. Inter-rater reliability was estimated and construct validity was tested based on a priori defined hypotheses. A 2.5-point (15%) change in the scale was considered clinically important.
We obtained 307 scores covering most of the scale's range, but a floor effect was clearly present. Inter-rater reliability was high between assessors (intraclass correlation coefficient = 0.96; 95% CI 0.92-0.98). Clinically important differences were seen between baseline and light sedation (3.1 points, p < 0.001) and between light and deep sedation (4.6 points, p = 0.002). The difference between baseline and our definition of a pain/distress state was not clinically important (1.5 points, p = 0.039).
The COMFORT behavioural scale can provide one aspect of an overall clinical assessment of sedation, and probably pain and distress, in toddlers before and after surgery.
开发COMFORT行为量表以评估无法表达疼痛的儿童的镇静、疼痛和痛苦程度。我们的目的是检验该量表在接受小手术的幼儿中的结构效度，并确定该量表的评分者间信度。
我们从挪威一家外科门诊护理单位连续招募了45名12至36个月大的儿童。在手术前后用COMFORT行为量表评估镇静、疼痛和痛苦程度。估计评分者间信度，并根据预先定义的假设检验结构效度。量表上2.5分（15%）的变化被认为具有临床意义。
我们获得了307个涵盖量表大部分范围的评分，但明显存在地板效应。评估者之间的评分者间信度很高（组内相关系数=0.96；95%CI 0.92-0.98）。在基线与轻度镇静之间（3.1分，p<0.001）以及轻度与深度镇静之间（4.6分，p=0.002）观察到具有临床意义的差异。基线与我们定义的疼痛/痛苦状态之间的差异不具有临床意义（1.5分，p=0.039）。
COMFORT行为量表可以为幼儿手术前后镇静以及可能的疼痛和痛苦的整体临床评估提供一个方面的信息。
