Validation of the Withdrawal Assessment Tool–1 in Adult Intensive Care Patients

Capilnean, Anissa; Martone, Amanda; Rosu, Vlad A.; Sandu, Patricia R.; Murgoi, Paul; Frenette, Anne Julie; Williamson, David; Lecavalier, Annie; Jayaraman, Dev; Rico, Philippe; Bellemare, Patrick; Gélinas, Céline; Perreault, Marc M.

doi:10.4037/ajcc2019559

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Critical Care Evaluation| September 01 2019

Validation of the Withdrawal Assessment Tool–1 in Adult Intensive Care Patients

Anissa Capilnean, PharmD, MSc;

Anissa Capilnean, PharmD, MSc

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Amanda Martone, PharmD, MSc;

Amanda Martone, PharmD, MSc

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Vlad A. Rosu, MSc, BPharm;

Vlad A. Rosu, MSc, BPharm

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Patricia R. Sandu, PharmD, MSc;

Patricia R. Sandu, PharmD, MSc

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Paul Murgoi, MSc, BPharm, BCPS;

Paul Murgoi, MSc, BPharm, BCPS

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Anne Julie Frenette, MSc, BPharm;

Anne Julie Frenette, MSc, BPharm

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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David Williamson, PhD;

David Williamson, PhD

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Annie Lecavalier, MD;

Annie Lecavalier, MD

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Dev Jayaraman, MD;

Dev Jayaraman, MD

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Philippe Rico, MD;

Philippe Rico, MD

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Patrick Bellemare, MD;

Patrick Bellemare, MD

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Céline Gélinas, PhD, RN;

Céline Gélinas, PhD, RN

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

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Marc M. Perreault, PharmD, MSc

Anissa Capilnean, Vlad A. Rosu, and Paul Murgoi are clinical pharmacists, Pharmacy Department, McGill University Health Center, Montreal, Canada. Amanda Martone is a clinical pharmacist, Pharmacy Department, Lakeshore Hospital, Montreal, Canada. Patricia R. Sandu is a clinical pharmacist, Pharmacy Department, Jewish General Hospital, Montreal, Canada. Anne Julie Frenette is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, and an associate clinical professor, Faculty of Pharmacy, University of Montreal, Montreal, Canada. David Williamson is a clinical pharmacist, Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, and a clinical professor, Faculty of Pharmacy, University of Montreal. Annie Lecavalier is a resident physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an adjunct professor, Faculty of Medicine, McGill University, Montreal, Canada. Dev Jayaraman is an attending physician, Critical Care Department, Montreal General Hospital, McGill University Health Center, and an associate professor, Faculty of Medicine, McGill University. Philippe Rico is a clinical adjunct professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Patrick Bellemare is an associate clinical professor, Faculty of Medicine, University of Montreal, and an intensivist, Critical Care Department, Hôpital du Sacré-Coeur de Montréal. Céline Gélinas is an associate professor, Ingram School of Nursing, McGill University, and a senior researcher, Center for Nursing Research and Lady Davis Institute, Jewish General Hospital. Marc M. Perreault is a clinical pharmacist, Pharmacy Department, McGill University Health Center, and a clinical professor, Faculty of Pharmacy, University of Montreal.

Corresponding author: Marc M. Perreault, pharmd, Pharmacy Department, Montreal General Hospital, C1-200 - 1650 Cedar Ave, Montreal, QC H3G 1A4, Canada (email: marc.perreault@umontreal.ca).

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Am J Crit Care (2019) 28 (5): 361–369.

https://doi.org/10.4037/ajcc2019559

Background

The Withdrawal Assessment Tool–1 (WAT-1) has been validated for assessing iatrogenic withdrawal syndrome in critically ill children receiving mechanical ventilation, but little is known about this syndrome in critically ill adults.

Objective

To evaluate the validity and reliability of the WAT-1 in critically ill adults.

Methods

A prospective, observational, open-cohort pilot study of critically ill adults receiving mechanical ventilation and regular administration of opioids for at least 72 hours. Patients were assessed for withdrawal twice daily on weekdays and once daily on weekends using the WAT-1 after an opioid weaning episode. The presence of iatrogenic withdrawal syndrome was evaluated once daily using modified Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. All evaluations were blinded and performed independently. The criterion validity of the WAT-1 and the interrater reliability for WAT-1 and DSM-5 evaluations were determined.

Results

During 8 months, 52 adults (median age, 51.5 years) were enrolled. Eight patients (15%) had at least 1 positive assessment during their intensive care unit stay using the DSM-5, compared with 19 patients (37%) using the WAT-1. The overall sensitivity of the WAT-1 was 50%, and its specificity was 65.9%. Agreement between WAT-1 and DSM-5 assessments was poor (κ = 0.102). The interrater reliability for the WAT-1 was 89.1% and for the DSM-5 was 90.1%.

Conclusion

Despite showing reliability, the WAT-1 is not a valid tool for assessing the presence of iatrogenic withdrawal syndrome in adults.

2019

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