Development of the Japanese version of the State Behavioral Scale for critically ill children

Abstract

Aims: The State Behavioral Scale (SBS) was developed to assess sedation states, including agitation, in pediatric patients on mechanical ventilation. The purpose of this study was to determine the reliability and validity of a back-translated Japanese version of the SBS.

Methods: Translation was done by the back-translation method followed by a prospective study in a Japanese intensive care unit. For reliability, a nurse/researcher pair evaluated SBS along eight dimensions (respiratory drive, response to ventilation, coughing, best response to stimulation, attentiveness to care provider, tolerance to care, consolability, and movement after consoled). For validity, SBS scores were compared to the Richmond Agitation-Sedation Scale and a visual analog scale (VAS).

Results: The original author approved the back-translated SBS. Thirty-one patients aged 0 weeks to 8 years were evaluated from 59 total critical pediatric patient encounters. The researcher and nurse SBS scores demonstrated excellent inter-rater reliability (weighted κ = 0.96, 95% CI 0.92-0.99). In addition, there was a very strong correlation between the researcher and nurse VAS scores (ρ = 0.80, P < 0.001). Weighted kappa coefficients for the eight dimensions ranged from 0.71 (95% confidence interval, 0.55-0.88; consolability) to 0.89 (95% confidence interval, 0.80-0.98; best response to stimulation). In validity testing, nurse SBS and nurse VAS scores were strongly correlated (ρ = 0.80, P < 0.001) with the researcher SBS and researcher Richmond Agitation-Sedation Scale scores (ρ = 0.91, P < 0.001).

Conclusion: This study suggests that our Japanese version of the SBS is valid and reliable for evaluating sedation for critically ill children.

Keywords: Agitation; State Behavioral Scale; pediatric intensive care; sedation.

Figure 1

Back‐translation method adapted from Jones et al.¹⁰ In step 1, the main researcher translated the original version of the state behavioral scale (SBS) from English to Japanese to create a tentative Japanese version. Step 2, this tentative Japanese version was retranslated into English to create a tentative English version by a professional translator not familiar with the SBS. Step 3, a committee of eight medical professionals (two clinical researchers, two intensivists, two pediatricians, and two pediatric intensive care nurses) discussed the differences between the original English version and the tentative English version to reduce variability through the expertise of a multidisciplinary medical team. Based on the findings of this discussion, the Japanese version was revised to create the final Japanese version. Step 4, the final Japanese version of SBS was once again back‐translated to English by a professional translator. In the final step, the final back‐translation was then checked by the original author.

Figure 2

Correlation between nurse visual analog scale (VAS) and nurse State Behavioral Scale (SBS). The results show that nurse SBS scores were strongly correlated with nurse VAS scores (ρ = 0.80, P < 0.001). Data are described as median and interquartile range from pediatric intensive care patient encounters (n = 59).

Figure 3

Results show that the researcher State Behavioral Scale (SBS) scores were strongly correlated with researcher Richmond Agitation–Sedation Scale (RASS) scores (ρ = 0.91, P < 0.001). Numbers in circles represent the number of pediatric intensive care patient encounters (n = 59).