# Cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese

## TL;DR

This study adapts a behavioral sedation scale for use in Brazil and finds it works well for assessing pediatric ICU patients.

## Contribution

A cross-culturally adapted Brazilian Portuguese version of the State Behavioral Scale with validated psychometric properties.

## Key findings

- The adapted scale showed high interrater agreement (ICC 0.939) and strong correlation with COMFORT-B (Spearman 0.884–0.908).
- Most patients (48.9% of observations) exhibited light sedation levels on the adapted scale.

## Abstract

To perform a cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese, assess its psychometric quality and use the scale to evaluate the level of sedation of patients on mechanical ventilation in the pediatric intensive care unit of a tertiary care hospital.

After receiving authorization by the main author, the State Behavioral Scale was adapted according to the following steps: translation of the original version into Portuguese; synthesis of the Portuguese versions; evaluation by a committee of judges; reverse translation by native speakers of the source language; synthesis of retroversions; pretest; and evaluation of psychometric quality.

The adapted scale was administered to 20 patients by four evaluators, who performed daily evaluations in pairs simultaneously and independently. The intraclass correlation coefficient was 0.939 (p < 0.001) for the State Behavioral Scale and 0.976 (p < 0.001) for the COMFORT-B scale. The two scales were strongly correlated, with Spearman coefficients ranging from 0.884 to 0.908 (p < 0.001). In the study sample, most children (n = 43 observations; 48.9%) had scores of -1 (responsive to light touch or voice) or 0 (awake and able to calm down), which corresponded to light sedation.

The translated and adapted version of the State Behavioral Scale showed high interrater agreement and high correlation with the COMFORT-B scale. The application of the scale showed an adequate level of sedation in most patients.