Validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) for monitoring iatrogenic withdrawal syndrome in pediatric patients.
Validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) for monitoring iatrogenic withdrawal syndrome in pediatric patients.
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DOI：
10.1016/j.pain.2011.10.003
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发表时间：
2012-01
期刊：
影响因子：
7.4
通讯作者：
Curley MAQ
中科院分区：
文献类型：
--
作者：
Franck LS;Scoppettuolo LA;Wypij D;Curley MAQ
重症儿科患者经常接受长时间的镇痛和镇静，以缓解疼痛并促进重症监护治疗。医源性戒断综合征发生在这些药物突然停止或断奶过快。我们调查了戒断评估工具-1（WAT-1）的有效性和普适性，在断奶的镇痛药和镇静剂的儿童。在308名最初接受机械通气治疗急性呼吸衰竭的儿童中，来自21个中心的126名（41%）（中位年龄1.6岁;四分位数范围：0.6-7.7岁）暴露于5天或更长时间的阿片类药物。使用WAT-1（11项（12分）量表）评估受试者的戒断症状，从脱离镇痛/镇静的第一天开始，直至末次阿片类药物给药后72小时。完成了836次每日WAT-1评估，每例受试者在6（3-9）天内的中位WAT-1评分为2（0-4）。WAT-1评分作为年龄的函数没有显著差异。因子分析证实，运动相关症状和行为状态占WAT-1评分的最大方差。支持结构效度，累积阿片类药物暴露量大于[40.2（19.7-83.4）与17.6（14.6-39.7）mg/kg，P=0.004]，断奶前阿片类药物给药时间较长[7（6-11）vs. 5（5-8）天，P=0.004]，与WAT-1评分< 3的受试者相比，WAT-1评分≥ 3的受试者的阿片类药物戒断时间更长[10（6-14）vs. 6（3-9）天，P=0.008]。WAT-1在儿科重症监护和普通病房中用于评估临床上重要的戒断症状时显示出良好的心理测量性能和普适性。
Critically ill pediatric patients frequently receive prolonged analgesia and sedation to provide pain relief and facilitate intensive care therapies. Iatrogenic withdrawal syndrome occurs when these drugs are stopped abruptly or weaned too rapidly. We investigated the validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) in children during weaning of analgesics and sedatives. Of 308 children initially supported on mechanical ventilation for acute respiratory failure, 126 (41%) from 21 centers (median age 1.6 years; interquartile range: 0.6–7.7 years) were exposed to 5 or more days of opioids. Subjects were assessed for withdrawal symptoms using the WAT-1, an 11-item (12-point) scale, from the first day of weaning from analgesia/sedation until 72 hours after the last opioid dose. 836 daily WAT-1 assessments were completed, with a median WAT-1 score of 2 (0–4) over 6 (3–9) days per subject. There were no significant differences in WAT-1 scores as a function of age. Factor analyses confirmed that motor-related symptoms and behavioral state accounted for the most variance in WAT-1 scores. Supporting construct validity, cumulative opioid exposures were greater [40.2 (19.7–83.4) vs. 17.6 (14.6–39.7) mg/kg, P=0.004], length of opioid treatment before weaning was longer [7 (6–11) vs. 5 (5–8) days, P=0.004], and length of weaning from opioids was longer [10 (6–14) vs. 6 (3–9) days, P=0.008] in subjects with WAT-1 scores ≥ 3 compared to subjects with WAT-1 scores < 3. The WAT-1 shows good psychometric performance and generalizability when used to assess clinically important withdrawal symptoms in pediatric intensive care and general ward settings.
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