SCIENTIFIC LETTER
Translation and cultural adaptation process to Spanish of the Preschool Confusion Assessment Method for the Intensive Care Unit
Traducción y adaptación cultural al español del
M.I. Figueroa-Ramosa,
, C.M. Arroyo-Novoaa, R.L. García-DeJesúsb, C.S. Sepúlveda-Santiagoa, S.S. Solís-Báeza, E.W. Elyc, H. Smithd
Corresponding author
a Escuela de Enfermería, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, Puerto Rico
b Escuela de Medicina, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, Puerto Rico
c Departamento de Medicina, Vanderbilt University Medical Center, Nashville, TN, USA
d Departamento de Anestesiología y Pediatría, Vanderbilt University Medical Center, Nashville, TN, USA
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"apellidos" => "Smith" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Escuela de Enfermería, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, Puerto Rico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Escuela de Medicina, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, Puerto Rico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina, Vanderbilt University Medical Center, Nashville, TN, USA" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Anestesiología y Pediatría, Vanderbilt University Medical Center, Nashville, TN, USA" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Traducción y adaptación cultural al español del" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1774 "Ancho" => 2508 "Tamanyo" => 890398 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Instructions for applying the psCAM-ICU-S.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Delirium is a very common brain functional disorder in patients admitted to the Pediatric Intensive Care Unit (PICU), with a reported prevalence of 11–44%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> The occurrence of delirium in the PICU is associated to negative outcomes such as prolonged PICU stay, increased hospitalization costs, and greater morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> Different studies have found that infants aged two years or younger are at a higher risk of developing delirium.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7,8</span></a> These observations support the need for validated instruments capable of detecting delirium.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The Preschool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU) was designed based on the criteria of the pCAM-ICU (patients between 5–19 years of age) and CAM-ICU (adults), which are validated and reliable instruments widely used to assess the presence of delirium.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,9</span></a> The psCAM-ICU evaluates the four key manifestations of delirium, based on the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), namely: acute change or fluctuation in mental state (1st criterion), inattention (2nd criterion), altered consciousness (3rd criterion) and disorganized brain (4th criterion). The evaluation of delirium involves two main steps: assessment of awakening using the Richmond Agitation – Sedation Scale (RASS) and the evaluation of consciousness content using the psCAM-ICU.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The translation and cultural adaptation of the psCAM-ICU was carried out using the 10 steps of the Principles of Good Practice (PGP) for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Step 1 (Preparation) involves the obtainment of authorization from the author of the original instrument and configuration of the working team. Dr. Heidi Smith agreed and participated as consultant throughout the process. The team comprised two research nurses, a certified translator (Spanish as mother tongue), three bilingual translators (English and Spanish) with prior experience in the translation of health-related instruments, two research assistants, a pediatric intensivist and a pediatric intensive care nurse. One of the translators acted as coordinator of the project.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In step 2 (Translation into Spanish), the certified translator and another translator carried out independent translations of the psCAM-ICU. In step 3 (Reconciliation), a panel composed of one of the research nurses, a translator and the project coordinator compared both Spanish translations and found them to be similar. However, a discrepancy was observed between the title of the fourth criterion (disorganized brain) and the questions that evaluate this criterion. This had also been reported by Matsuishi et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> in the translation of the psCAM-ICU into Japanese. The mentioned criterion refers to disorganization of thought or function, which in infants and preschool children manifests with alteration of the sleep-wake rhythm, inconsolability and/or a lack of recognition of the environment or parents / caregivers.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> At the time of development of the original instrument, these three components described the fourth criterion (disorganized brain); however, following a component sensitivity and specificity analysis, two of the components were eliminated, leaving only alteration of the sleep-wake rhythm for clinical evaluation. Since the term “disorganized brain” is confusing and this criterion only evaluates alteration of the sleep-wake rhythm, the research team in consultation with the author of the original instrument determined that the most adequate title for the fourth criterion would be “sleep-wake rhythm disorder”. Following consensus regarding the content, a preliminary version of the instrument in Spanish was developed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Steps 4 and 5 (Backtranslation into English and Review of the backtranslation) involved the participation of two translators that had not taken part in the previous steps. Two versions of the preliminary version in Spanish translated into English were produced and then compared against the original version of the instrument (in English) by the project coordinator. Both translations were seen to be similar to the original version. In step 6 (Harmonization), a comparison table was developed, including information on the original instrument, the backtranslation version and explanations to justify the discrepancies found or the changes made. The mentioned table was shared and discussed with Dr. Smith, the author of the original psCAM-ICU.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Step 7 (Cognitive evaluation of the instrument) suggests administration of the translated instrument to a group of participants belonging to the population of interest in order to identify comprehension problems. For this purpose, two assistant research nurses administered the psCAM-ICU (preliminary version in Spanish) to 10 children between 6 months and 5 years of age. The instructions and questions were easily understood by the children. In step 8 (Review of cognitive evaluation of the instrument), the nurses, a translator and one of the research nurses met to discuss the findings of application of the psCAM-ICU. Furthermore, one of the research nurses met with the pediatric intensivist and pediatric intensive care nurse to assess semantic, conceptual and experience equivalences. This allowed evaluation of the clarity of words or phrases, the quality of writing, and its pertinence to Puerto Rican culture.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Step 9 (Correction of the new version in Spanish) was carried out to check the presence of errors, and the final version in Spanish was completed (psCAM-ICU-S), along with the instructions for applying the instrument (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). These can be accessed at <a href="https://www.icudelirium.org/">https://www.icudelirium.org/</a>. Lastly, step 10 (Final report) involved the preparation of a final report that was shared with the author of the original instrument (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">We have adapted the psCAM-ICU-S in its cultural and linguistic domains for Spanish-speaking caregivers and patients between 6 months and 5 years of age. Incorporation of this instrument to the clinical scenario will contribute to future studies and to the identification of reliable results referred to delirium.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no funding was received for carrying out this work.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "xack484881" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Figueroa-Ramosa MI, Arroyo-Novoa CM, García-DeJesús RL, Sepúlveda-Santiago CS, Solís-Báez SS, Ely EW, et al. Traducción y adaptación cultural al español del <span class="elsevierStyleItalic">Preschool Confusion Assessment Method for the Intensive Care Unit</span>. Med Intensiva. 2020;44:453–456.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1827 "Ancho" => 2511 "Tamanyo" => 823169 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The psCAM-ICU-S.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1774 "Ancho" => 2508 "Tamanyo" => 890398 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Instructions for applying the psCAM-ICU-S.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1900 "Ancho" => 2508 "Tamanyo" => 583533 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Translation and cultural adaptation process of the psCAM-ICU.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This figure describes the steps and results of the translation and cultural adaptation process to Spanish of the psCAM-ICU.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric delirium and associated risk factors: A single-center prospective observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. 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Verjee-Lorenz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Value Heal" "fecha" => "2005" "volumen" => "8" "paginaInicial" => "94" "paginaFinal" => "104" "itemHostRev" => array:3 [ "pii" => "S1878875018318655" "estado" => "S300" "issn" => "18788750" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of the Japanese version of the Preschool Confusion Assessment Method for the ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Matsuishi" 1 => "H. Hoshino" 2 => "N. Shimojo" 3 => "Y. Enomoto" 4 => "T. Kido" 5 => "S. Jesmin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ams2.306" "Revista" => array:6 [ "tituloSerie" => "Acute Med Surg" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "102" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29445508" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack484881" "titulo" => "Acknowledgments" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">Thanks are due to the nursing staff of the Intensive Care Unit of the University Pediatric Hospital of Puerto Rico, and to Prof. Gladys Vélez and Dr. Elizabeth Román as translators.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004400000007/v1_202010040640/S2173572719301778/v1_202010040640/en/main.assets" "Apartado" => array:4 [ "identificador" => "15647" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004400000007/v1_202010040640/S2173572719301778/v1_202010040640/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301778?idApp=WMIE" ]
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