Most Tools for Assessing Pain, Sedation in Preverbal Kids Not Well Validated

By Reuters Staff

October 18, 2019

NEW YORK (Reuters Health) - Most scales for assessing pain and sedation in preverbal children have not been well validated, according to a new systematic review.

Twenty-eight of 65 scales included in the review had been tested for construct validity, internal consistency and interrater reliability, Dr. Vito Giordano of the Medical University of Vienna and colleagues found.

"Despite a large number of scales with a variety of psychometric properties having been published in the last decades, to date, there is no criterion standard when considering the assessment of pain and sedation in patients in preverbal stages of development," the authors note in JAMA Pediatrics, online October 14.

They reviewed 89 validation articles including 65 scales. Fifty-seven of the scales were useful for pain assessment, 13 were useful for assessing sedation, and four were useful for both. About two-thirds of the scales were behavioral and a third were multidimensional.

Eleven scales had been validated for infants on mechanical ventilation; 37 for preterm infants; 24 for term and preterm infants; seven for children born at term; seven for preterm infants, term infants and toddlers; and 17 for term infants and toddlers.

The American Academy of Pediatrics (AAP) recommends five scales, the authors note: the Neonatal Facial Coding System (NFCS); the Premature Infant Pain Profile (PIPP); the Neonatal Pain, Agitation and Sedation Scale (N-PASS); the Behavioral Indicators of Infant Pain (BIIP) scale and the Acute Pain in Newborns/Douleur Aigue du Nouveau-ne (APN/DAN) scale, the authors note.

All scales recommended by the AAP are relevant, although bias risk is lower with NFCS, PIPP and N-PASS than with BIIP and APN/DAN, according to the authors.

Other scales with a lower risk of bias include COMFORT, Echelle Douleur Inconfort Nouveau-Né (EDIN) and the EVENDOL behavioral pain scale, they add.

"Going beyond the concept of validity, it is important from a clinical point of view to concretely define cutoff points for the discrimination of different levels of pain or sedation. Cutoff points could be helpful for the establishment of adequate intervention according to a predefined protocol for the treatment of patients," Dr. Giordano and colleagues write.

"We suggest the use of scales that are validated for construct validity, internal consistency, and interrater reliability and further suggest choosing a particular scale based on the population of interest and the construct intended to measure," they conclude.

The study includes a flowchart in which the most relevant scales are organized for clinical applicability.


JAMA Pediatr 2019.


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