Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Aust Crit Care. 2018 Sep;31(5):266-273. doi: 10.1016/j.aucc.2017.07.006. Epub 2017 Aug 24.
Delirium in critically ill children is a severe neuropsychiatric disorder which has gained increased attention from clinicians. Early identification of delirium is essential for successful management. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale was developed to detect Paediatric Delirium (PD) at an early stage.
The aim of this study was to determine the measurement properties of the PD component of the SOS-PD scale in critically ill children.
A prospective, observational study was performed in patients aged 3 months or older and admitted for more than 48h. These patients were assessed with the SOS-PD scale three times a day. If the SOS-PD total score was 4 or higher in two consecutive observations, the child psychiatrist was consulted to assess the diagnosis of PD using the Diagnostic and Statistical Manual-IV criteria as the "gold standard". The child psychiatrist was blinded to outcomes of the SOS-PD. The interrater reliability of the SOS-PD between the care-giving nurse and a researcher was calculated with the intraclass correlation coefficient (ICC).
A total of 2088 assessments were performed in 146 children (median age 49 months; IQR 13-140). The ICC of 16 paired nurse-researcher observations was 0.90 (95% CI 0.70-0.96). We compared 63 diagnoses of the child psychiatrist versus SOS-PD assessments in 14 patients, in 13 of whom the diagnosis of PD was confirmed. The sensitivity was 96.8% (95% CI 80.4-99.5%) and the specificity was 92.0% (95% CI 59.7-98.9%).
The SOS-PD scale shows promising validity for early screening of PD. Further evidence should be obtained from an international multicentre study.
危重病患儿的谵妄是一种严重的神经精神疾病，已引起临床医生的高度关注。早期识别谵妄对于成功治疗至关重要。Sophia 观察撤药症状-小儿谵妄（SOS-PD）量表的开发是为了在早期发现小儿谵妄（PD）。
本研究旨在确定 SOS-PD 量表 PD 成分的测量特性在危重病患儿中的应用。
前瞻性观察研究在年龄 3 个月或以上且住院时间超过 48 小时的患者中进行。这些患者每天接受 SOS-PD 量表评估 3 次。如果在连续两次观察中 SOS-PD 总分达到 4 或更高，则咨询儿童精神科医生，使用诊断和统计手册-IV 标准作为“金标准”评估 PD 的诊断。儿童精神科医生对 SOS-PD 的结果不知情。照顾护士和研究人员之间的 SOS-PD 评分的组内相关系数（ICC）来计算。
共对 146 名儿童的 2088 次评估进行了评估（中位数年龄为 49 个月；IQR 13-140）。16 对护士-研究人员观察的 ICC 为 0.90（95%CI 0.70-0.96）。我们比较了 14 名患者中儿童精神科医生的 63 例诊断与 SOS-PD 评估，其中 13 例 PD 诊断得到证实。敏感性为 96.8%（95%CI 80.4-99.5%），特异性为 92.0%（95%CI 59.7-98.9%）。
SOS-PD 量表对 PD 的早期筛查具有良好的有效性。应从国际多中心研究中获得更多证据。
