Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children

Abstract

Objective: To construct a reliable and clinically practical instrument for monitoring opioids and benzodiazepine withdrawal symptoms in pediatric ICU patients. Design: Instrument development. Setting: Intensive care unit in an academic children's hospital. Patients and participants: 79 patients up to age 16 years on intravenous midazolam and/or opioids for C5 days. An expert panel of 85 physicians and nurses rated clinical relevance of withdrawal symptoms. Intervention: During drug weaning repeated observations were performed with a checklist of 24 withdrawal symptoms described in the literature. Measurements and results: For 76 children, 932 observations were obtained within 24 h after decrease and/or discontinuation of midazolam or opioids. Most frequent symptoms were tachypnea, agitation, motor disturbance, diarrhea, fever, anxiety, sleep disturbance and hypertension (14.6-29.6%). Multidimensional scaling (MDS) was performed to detect the underlying empirical structure of co-occurrences of symptoms. An expert panel judged clinical relevance of each withdrawal symptom on a four-point scale ranging from 'definitively so' to 'definitively not'. Agitation, anxiety, inconsolable crying, increased muscle tension, tremors, tachycardia and sweating were considered relevant by 85-95% of the experts. On the basis of the MDS results and the experts' opinions, 15 symptoms were included in the final instrument. Conclusions: We are the first to develop an assessment tool for withdrawal symptoms in pediatric ICU patients on the basis of the underlying empirical structure of co-occurrences of withdrawal symptoms that experts considered relevant. Future studies need to define cut-off points and clarify psychometric issues.

An Electronic Delphi Study to Establish Pediatric Intensive Care Nursing Research Priorities in Twenty European Countries*

“…Another group of nurse researchers is active in pain and sedation management. They developed several scales to assess pain and sedation (23)(24)(25). This may explain the higher ranking of pain and sedation, by the nonclinical group of nurses, possibly the influence of the nurse researchers.…”

The KIDS SAFE Checklist for Pediatric Intensive Care Units

“…65 Inclusion of sedation in the checklist provides a reminder to nurses to consider progression through sedation protocols, 65 reflect on the appropriateness of current sedation strategies, 64,69 and assess patients for symptoms of tolerance or withdrawal [70][71][72] by using a validated tool when available (eg, Withdrawal Assessment Tool 73 ). The aim of this element is to reduce inappropriate levels of sedation and facilitate early recognition and treatment of the adverse effects associated with sedation.…”

Nursing judgement and decision‐making using the Sedation Withdrawal Score (SWS) in children

“…Both WAT-1 (Franck et al 2008(Franck et al , 2012 and SOS (Ista et al 2009(Ista et al , 2013 have been validated but the studies excluded patients whose existing behaviour might confound the withdrawal assessment and clinical utility is further limited by the lack of linked treatment protocols.…”

“…Structured and repeatable assessments are recommended to assist detection, but it is often unclear how these are applied by nurses. Three published tools have been developed to monitor withdrawal in children; the Sedation Withdrawal Score (SWS) (Cunliffe et al 2004), the Withdrawal Assessment Tool (WAT-1) (Franck et al 2008) and the Sophia Observation Score (SOS) (Ista et al 2009). …”

“…Complex tasks like this demand a degree of cognitive effort and focussed attention on the part of the nurse, to make correct judgments and decisions. Given that the judgement of the bedside nurse has been a 'silver standard' in tool validation studies (Franck et al 2008, Ista et al 2009, it is important to understand how nurses think when undertaking withdrawal assessments and making treatment choices (Easley & Nichols 2008).…”