Chandran Vanmathi, Jagadisan Barath, Ganth Barani
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Department of Applied Psychology, Pondicherry University, Pondicherry, India.
Paediatr Anaesth. 2017 Jun;27(6):621-628. doi: 10.1111/pan.13127. Epub 2017 Apr 3.
Pediatric esophagogastroduodenoscopy requires deep sedation as it involves stimulation of the airway. Frequency of adverse events is higher with esophagogastroduodenoscopy. Hence, monitoring needs sedation scales like the Dartmouth Operative Condition Scale that identifies safe states of sedation. This study aims at validating the Adapted Dartmouth Operative Condition Scale for sedation rating by pediatricians during pediatric esophagogastroduodenoscopy.
Items in the Dartmouth Operating Conditions Scale were adapted for pediatric esophagogastroduodenoscopy. Videos of 35 procedures were recorded. The recording started 10 min before sedation and continued till recovery. The videos were split into preprocedure videos, intraprocedure videos, and recovery videos, and further split into 30-s clips. Twenty representative intraprocedure videos clips were selected. Ten raters scored the videos with the Adapted Dartmouth Operating Conditions Scale and modified-COMFORT score. The Adapted Dartmouth Operating Conditions Scale scoring was repeated after a month. The preprocedure videos, intraprocedure videos, and recovery videos of ten patients (six clips each) were scored by one rater to assess responsiveness.
The Adapted Dartmouth Operating Conditions Scale detected nonoptimal sedation states including laryngospasm due to undersedated states. It showed fair interrater reliability at timeline-1 (intraclass correlation coefficient = 0.45) and timeline-2 (intraclass correlation coefficient = 0.65) but poor intrarater reliability (intraclass correlation coefficient = 0.32). There was significant positive correlation with modified-COMFORT (Spearman's rank order correlation, r = 0.150). Responsiveness was demonstrated by the difference in the preprocedure videos, intraprocedure videos, and recovery videos scores (F = 126.50).
The Adapted Dartmouth Operating Conditions Scale detects nonoptimal sedation states during pediatric-esophagogastroduodenoscopy. It shows good criterion validity, interrater reliability, and responsiveness. Poor intrarater reliability seen in our study could be due to item ambiguity arising from the mode of training of the raters in the Dartmouth Operating Conditions Scale.
小儿食管胃十二指肠镜检查因涉及气道刺激，需要深度镇静。食管胃十二指肠镜检查的不良事件发生率较高。因此，监测需要使用如达特茅斯手术状态量表这样的镇静量表来确定安全的镇静状态。本研究旨在验证儿科医生在小儿食管胃十二指肠镜检查期间使用的改良达特茅斯手术状态量表用于镇静评分的有效性。
对达特茅斯手术状态量表中的条目进行改编以适用于小儿食管胃十二指肠镜检查。记录了35例手术的视频。记录从镇静前10分钟开始，持续至恢复阶段。视频被分为术前视频、术中视频和恢复视频，并进一步分成30秒的片段。选择了20个有代表性的术中视频片段。10名评分者使用改良达特茅斯手术状态量表和改良舒适评分对视频进行评分。一个月后重复使用改良达特茅斯手术状态量表评分。由一名评分者对10名患者的术前视频、术中视频和恢复视频（各6个片段）进行评分，以评估反应性。
改良达特茅斯手术状态量表能检测到非最佳镇静状态，包括因镇静不足导致的喉痉挛。在时间点1（组内相关系数 = 0.45）和时间点2（组内相关系数 = 0.65）显示出尚可的评分者间信度，但评分者内信度较差（组内相关系数 = 0.32）。与改良舒适评分有显著正相关（斯皮尔曼等级相关系数，r = 0.150）。术前视频、术中视频和恢复视频评分的差异证明了反应性（F = 126.50）。
改良达特茅斯手术状态量表可检测小儿食管胃十二指肠镜检查期间的非最佳镇静状态。它显示出良好的效标效度、评分者间信度和反应性。我们研究中观察到的评分者内信度较差可能是由于评分者在达特茅斯手术状态量表培训模式下产生的条目模糊性所致。
