The Withdrawal Assessment Tool-1 (WAT-1): An assessment. instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients
The Withdrawal Assessment Tool-1 (WAT-1): An assessment. instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients
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DOI：
10.1097/pcc.0b013e31818c8328
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发表时间：
2008-11-01
影响因子：
4.1
通讯作者：
Curley, Martha A. Q.
中科院分区：
文献类型：
--
作者：
Franck, Linda S.;Harris, Sion Kim;Curley, Martha A. Q.
目的：编制和检验儿童阿片类药物和苯二氮卓类药物戒断症状监测工具-1的效度和信度。设计：前瞻性心理测评。儿科重症监护护士评估符合条件的高危儿科患者是否存在19种戒断症状，并使用数字评分表对患者的总体戒断强度进行评级，其中0表示没有戒断，10表示可能最严重的戒断。19种症状来源于阿片类药物和苯二氮卓类药物戒断评分、文献和专家意见。大学附属专科儿童医院的两个儿科重症监护病房。患者：83名儿童患者，中位年龄35mos(四分位数范围：7mos-10岁)，从持续输注或全天候阿片类药物和苯二氮卓类药物治疗超过5天的急性呼吸衰竭中恢复。在镇痛和镇静撤机期间反复观察。总共完成了1040次戒断症状评估，每个患者在6.6(4.8-11)天内的中位数(四分位数范围)为11(6-16)。测量和主要结果：使用广义线性模型分析每个症状与戒断强度评级的关系，调整了地点、受试者和年龄组。与戒断强度等级相关的高冗余或低水平相关的症状被删除，产生了11个条目(12分)的量表。戒断评估工具-1和3预测数字评定量表的敏感度和特异度分别为0.872和0.880。戒断评估工具-1和戒断评估工具-3的患者在药物暴露、治疗时间、镇静撤除时间、机械通气时间和重症监护病房停留时间等方面与得分较低的患者相比，其结构效度有显著差异。结论：戒断评估工具-1用于评估儿科重症监护病房中临床重要的戒断症状时，具有良好的初步心理测量学表现。需要在不同的高危人群中进行进一步的心理测量评估。(《儿科急救医学》2008；9：573-580)
Objective: To develop and test the validity and reliability of the Withdrawal Assessment Tool-1 for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients.Design: Prospective psychometric evaluation. Pediatric critical care nurses assessed eligible at-risk pediatric patients for the presence of 19 withdrawal symptoms and rated the patient's overall withdrawal intensity using a Numeric Rating Scale where zero indicated no withdrawal and 10 indicated worst possible withdrawal. The 19 symptoms were derived from the Opioid and Benzodiazepine Withdrawal Score, the literature and expert opinion.Setting. Two pediatric intensive care units in university-affiliated academic children's hospitals.Patients: Eighty-three pediatric patients, median age 35 mos (interquartile range: 7 mos-10 yrs), recovering from acute respiratory failure who were being weaned from more than 5 days of continuous infusion or round-the-clock opioid and benzodiazepine administration.Interventions. Repeated observations during analgesia and sedative weaning. A total of 1040 withdrawal symptom assessments were completed, with a median (interquartile range) of 11 (6-16) per patient over 6.6 (4.8-11) days.Measurements and Main Results: Generalized linear modeling was used to analyze each symptom in relation to withdrawal intensity ratings, adjusted for site, subject, and age group. Symptoms with high redundancy or low levels of association with withdrawal intensity ratings were dropped, resulting in an 11-item (12-point) scale. Concurrent validity was indicated by high sensitivity (0.872) and specificity (0.880) for Withdrawal Assessment Tool-1 > 3 predicting Numeric Rating Scale > 4. Construct validity was supported by significant differences in drug exposure, length of treatment and weaning from sedation, length of mechanical ventilation and intensive care unit stay for patients with Withdrawal Assessment Tool-1 scores > 3 compared with those with lower scores.Conclusions., The Withdrawal Assessment Tool-1 shows excellent preliminary psychometric performance when used to assess clinically important withdrawal symptoms in the pediatric intensive care unit setting. Further psychometric evaluation in diverse at-risk groups is needed. (Pediatr Crit Care Med 2008; 9:573-580)