title: Assessment of sedation levels in pediatric intensive care patients can be improved by using the COMFORT "behavior" scale.
abstract: OBJECTIVE
  The original COMFORT scale, including both observational and physiologic items, has been validated for measuring distress in children admitted to a pediatric intensive care unit. However, physiologic variables are influenced by drugs given in the pediatric intensive care unit setting. The objectives of this study were to assess the usefulness of physiologic variables in judgment of sedation and to determine new cutoff points for the COMFORT "behavioral" scale (COMFORT-B), using only observational items.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Pediatric intensive care unit in a university hospital.
  
  
  METHODS
  Seventy-eight patients admitted to the pediatric intensive care unit.
  
  
  METHODS
  None.
  
  
  RESULTS
  COMFORT scores were obtained in this patient group. Similar to the original COMFORT scale validation, the expert opinion of nurses (Nurse Interpretation Score of Sedation) served to determine optimal cutoff scores for the COMFORT-B scale. A total of 843 combined COMFORT and Nurse Interpretation Score of Sedation scores were obtained in 78 patients. Cronbach's alpha for the COMFORT scale was .78, increasing to .84 when the physiologic items, blood pressure and heart rate, were excluded. COMFORT scores were significantly different for the three Nurse Interpretation Score of Sedation categories (Kruskal-Wallis, p < .001). According to the pediatric intensive care unit nurses, undersedation was present in 11% and oversedation in 3% of all observations. Cutoff points for the COMFORT-B scale were </=10 for oversedation and >/=23 for undersedation. The area in the COMFORT-B score between 11 and 22 does not adequately predict under- or oversedation, pointing to a need for supplemental observation.
  
  
  CONCLUSIONS
  The COMFORT-B scale is a reliable alternative to the original COMFORT scale. The cutoff points of the COMFORT-B scale in conjunction with the Nurse Interpretation Score of Sedation facilitate the use of sedation algorithms on the pediatric intensive care unit.
authors.affiliation: Department of Pediatrics, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ista
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Matthijs
authors.initials: M
authors.lastname: de Hoog
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000592:standards / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000145:classification / Q000451:nursing / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008991:Monitoring, Physiologic; D009426:Netherlands; D009730:Nursing Assessment; D019370:Observation; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D013315:Stress, Psychological
chemical_list: D000700:Analgesics