Adaptação transcultural da ferramenta SOS-PD para o português do Brasil para diagnóstico de síndrome de abstinência e delirium em unidades de terapia intensiva pediátrica

Abstract

Patients admitted to Pediatric Intensive Care Units (PICU) and Neonatal Intensive Care Units (NICU) frequently require analgesics and sedatives to relieve pain, reduce hospitalization stress, and minimize the accidental removal of invasive devices. However, the prolonged use of opioids and benzodiazepines can lead to the development of tolerance, physiological dependence, and iatrogenic withdrawal syndrome (IWS), especially when medication discontinuation occurs abruptly. In addition to IWS, the inappropriate or prolonged use of these medications is associated with delirium, a neurobehavioral syndrome that negatively impacts morbidity, mortality, and quality of life after discharge. To improve the identification of these conditions, the Sophia Observation Withdrawal Symptoms scale (SOS) was adapted to include the diagnosis of pediatric delirium, resulting in the SOS-PD version. This study followed the guidelines of the International Society for Health Economics and Outcomes Research (ISPOR) for this tool's cross-cultural adaptation (CCA), ensuring its diagnostic accuracy and cultural adequacy to the Brazilian context. The objective of this study was to carry out the CCA of the SOS-PD tool translated into Brazilian Portuguese for diagnosing IWS and delirium in children in PICUs. To perform the semantic and operational equivalence steps of the SOS-PD version translated into Brazilian Portuguese as part of the tool's CCA process, 26 evaluations were conducted in 13 hospitalized patients eligible for the applicability of the SOS-PD scale by healthcare professionals working in PICUs. After applying the scale, these professionals answered a questionnaire with a Likert-type scale regarding each construct item, assessing clarity and comprehension. A content validity index was applied to the questionnaire responses to evaluate whether the items were well understood, facilitating their application in Brazil. The questionnaire responses regarding the understanding of the scale constructs indicated greater difficulty with some items related to delirium assessment. The CVI for the responses ranged from an average of 0.88 to 1.0, indicating good comprehension of the scale. This study demonstrated good performance in translating and cross-culturally adapting the SOS-PD scale into Brazilian Portuguese. The evaluators showed good understanding of the tool, which can be further complemented in future studies with a validation phase for use in Brazilian PICUs.