Comparison Of Three Scales For Acute Pain Assessment In Neonates With Mechanical Ventilation

BackgroundCritically ill neonates suffered from frequent acute pain stimulus due to various diagnostic and therapeutic procedures.Their pain assessment and relief were inadequate,which may lead to adverse changes on physiological dysfunction and altered sensory sensitivity.Neonates cannot express their pain,so they have to rely on pain assessment scale with physiological,behavioral and other indicators to identify and assess pain.Although pain assessment instruments are available to assess neonatal pain,few have been used for the mechanically ventilated neonates with acute pain.Morever,the feasibility and clinical utility of the three scales are limited.ObjectivesTo compare the reliability,validity,feasibility,clinical utility,and nurses'preferenceof three scales for measuring acute procedural pain in neonates with invasive mechanical ventilation.MethodsParticipants:Ninety neonates with invasive mechanical ventilation and forty nurses were recruited from the neonatal intensive care uint(NICU)of Department of Pediatrics in a university affiliated hospital.Instruments:1)Premature Infant Pain Profile-Revised(PIPP-R)with seven items with total score ranged from 0 to 21 points.2)Neonatal Pain,Agitation,and Sedation Scale(N-PASS)with five items with total score ranged from 0 to 11 points.3)Neonatal Infant Acute Pain Assessment Scale(NIAPAS)has nine items with total score ranged from 0 to 18 points.4)Feasibility and clinical utility questionnaire with 10 items with total score range from 0 to 50 points.Study procedure:When NICU nurses administrated the painful and nonpainful procedures(arterial blood sampling and diaper change,respectively),changes in physiological and behavioral indicators of each neonate thoughout the procedures were videotaped.Then,two researchers observed those video recordings independently and assessed neonates pain using the above three scales during and after the painful and nonpainful procedures.The internal consistency,interrater reliability,discriminant validity,and criterion-related validity of the three scales were evaluated.In addition,nurses were asked to complete a questionnaire including the feasibility,clinic utility,and nurses'preference of the three scales.Results1)The PIPP-R,the N-PASS,and the NIAPAS showed high coefficients for inter-rater(0.991,0.992,0.991),along with internal consistency of 0.708,0.829 and 0.829,respectively.2)Painful procedures scores of the three scales were significantly higher than those nonpainful procedures scores(9.49± 5.306 vs 5.50 ± 4.631,Z=-10.849,P<0.001;4.19 ± 3.302 vs 1.76 ± 2.317,2 =-9.817,P<0.001;6.70 ? 4.493 vs 3.46±3.010,Z =-9.823,P<0.001,respectively).Criterion-related validity between each scale were good with significantly high correlations(r = 0.824?0.846,P<0.001)in painful and nonpainful procedures.3)Mean scores of feasibility and clinical utility for the N-PASS was significantly higher than the NIAPAS(39.00 ± 8.373 vs 33.95 ± 8.581,P<0.05),but not significantly higher than the PIPP-R(39.00 ± 8.373 vs 36.63 ± 7.870,P>0.05).Forty nurses agreed that three scales were feasible and helpful,with over half of them(55.9%)preferred the N-PASS,and followed by the NIAPAS(23.5%)and the PIPP-R(20.6%).ConclusionsThree scales are reliable and valid,but the N-PASS and the NIAPAS have better internal consistency reliability for assessing acute pain in neonates with mechanical ventilation.The N-PASS appears to be a better choice based on feasibility,utility,and nurses' preference.