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Psychometric Evaluation of the Sophia Observation Withdrawal Symptoms Scale in Critically Ill Children

Ista, Erwin PhD, RN; de Hoog, Matthijs MD, PhD; Tibboel, Dick MD, PhD; Duivenvoorden, Hugo J. MD, PhD; van Dijk, Monique PhD

Pediatric Critical Care Medicine: October 2013 - Volume 14 - Issue 8 - p 761–769
doi: 10.1097/PCC.0b013e31829f5be1
Feature Articles

Objective: The Sophia Observation withdrawal Symptoms scale is an instrument for screening benzodiazepine and opioid withdrawal syndrome in pediatric critical care patients. The objectives of this study were to establish cutoff scores and to test sensitivity to change. Second, risk factors for withdrawal syndrome were explored.

Design: Prospective observational study with repeated measures.

Setting: Level IV ICU at a university children’s hospital.

Patients: A total of 154 children with median age 5 months (interquartile range, 0–42 mo) who received continuous infusion of benzodiazepines and/or opioids for 5 or more days.

Interventions: None.

Measurements and Main Results: Nurses repeatedly applied the Sophia Observation withdrawal Symptoms scale and the Numeric Rating Scale withdrawal when children were weaned off benzodiazepines and opioids. The latter represents the nurse’s expert opinion. We analyzed 3,754 paired assessments; the median number per child was 15 (interquartile range, 7–31) over a median of 5 days (interquartile range, 3–11 d). Sensitivity and specificity were 0.83 and 0.93, respectively, for the Sophia Observation withdrawal Symptoms scale cutoff score of 4 or higher against a Numeric Rating Scale-withdrawal score of 4 or higher. Sensitivity to change was determined by comparing 156 Sophia Observation withdrawal Symptoms scale assessments (n = 51 patients) before and after additional sedatives or opioids. Multilevel regression analysis showed a mean decline of 1.5 points (at score range 0–15) after intervention (p < 0.0001). Logistic regression analysis identified duration of preweaning of midazolam, duration of weaning of midazolam, duration of preweaning of morphine, duration of weaning of morphine, and number of additional sedatives/opioids as statistically significant risk factors for withdrawal syndrome in these children.

Conclusions: The Sophia Observation withdrawal Symptoms scale is a valid tool with good psychometric properties to assess withdrawal symptoms in PICU patients.

All authors: Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

The authors have disclosed that they do not have any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies