Comparison of two neonatal pain assessment tools (Children and Infant’s Postoperative Pain Scale and the Neonatal Facial Coding System—Revised) and their relations to clinicians’ intuitive pain estimates

Abstract

Background Many neonatal observational pain assessment tools are available. Their application in clinical settings, however, has been limited. A further difficulty for decision makers may be to choose among the variety of available tools the appropriate one(s) for their patients. Aims of the present study were (1) to compare two commonly cited neonatal pain assessment tools, the Neonatal Facial Coding System—Revised (NFCS‐R) and the Children and Infant’s Postoperative Pain Scale (CHIPPS), with regard to their psychometric qualities and (2) to explore intuitive clinicians’ ratings by relating them to the tools’ items. Methods Three coders applied both pain assessment tools to videos of 44 neonates who were videotaped while undergoing a painful and a stressful procedure. Clinicians rated the pain neonates experienced on a numerical rating scale. Analyses of variances and regression analyses were used to investigate whether tools could discriminate between the procedures and whether tools’ items were predictors of intuitive clinicians’ ratings. Results Interrater reliability, internal consistency and relative convergent validity were high for both assessment tools. Both tools discriminated between painful and stressful situations equally well. Roughly one third of variance in clinicians’ intuitive ratings could be explained by items of each tool, however, no single item was found to be a significant predictor. Conclusions Both pain assessment tools performed equally well regarding psychometric comparisons. Therefore, clinical utility needs to be considered when having to choose. Possibilities of improvement for both tools were identified. Cues clinicians base their intuitive pain judgements need to be further investigated. Significance Psychometric comparisons of neonatal assessment tools provide useful information that can help health care professionals to choose among tools and researchers to improve them. Both tools compared here performed psychometrically equally well. Their clinical utility, however, can be improved, for example by providing a manual (CHIPPS) and training opportunities.

Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

“…Pain was assessed prospectively from a direct observation of the child, which best reflects clinical practice, where rapid assessments are needed. Indeed, most pain scales have been validated from videos of children (Gilbert et al, 1999;Kappesser et al, 2019;Malviya et al, 2006;Peters et al, 2003;Voepel-Lewis et al, 2002). In addition, assessment by nurses reflects real life, because nurses are the caregivers assigned to using these tools in routine practice (Zisk-Rony et al, 2015).…”

“…The five items of the FASS are also found in the Child Facial Coding System (CFCS) scale created by Gilbert in 1999 and which is validated postoperatively in preschool children (Gilbert et al, 1999). Most pain scales based on facial expression have been studied for brief pain such as vaccination or blood sampling (DiLorenzo et al, 2018;Kappesser et al, 2019). The CFCS based on 13 action units was the first facial scale that accurately describes children's postoperative pain.…”

Expanded Analysis of a Modified Enhanced Recovery Protocol in Cleft Palatoplasty

“…Currently in the literature, the Wong-Baker FACES scale has been validated as young as age 7, with ages 4 to 7 of speculative validity depending on patient maturity (Tsze et al, 2013). The Children and Infant’s Postoperative Pain Scale and the Neonatal Facial Coding System have been proposed for younger patients, including those less than 1-year-old, but are significantly criticized for their subjectivity as observational pain scales and are confounded by inconsistencies in provider assessment and reporting (Kappesser et al, 2019). Consistent with reporting trends in the pediatric anesthesia pain literature, the authors again utilize narcotic equivalency as the primary method of assessing pain control trends in the comparison of our 2 groups.…”

Itemreduktion zur Verbesserung der Praktikabilität neonatologischer Schmerzmesssysteme

“…Die vorliegende Studie zielte darauf ab zu evaluieren, ob eine Reduktion der Items der Beobachtungsverfahren NFCSshort und PIPP zu Gunsten der Alltagspraktikabilität durchführbar ist. Die meisten Verfahren, die in den letzten Jahren entwickelt wurden, sind hauptsächlich unter Laborbedingungen evaluiert [6], verfügen jeweils über vergleichbar gute psychometrische Gütekriterien [14,15], jedoch werden nur wenige im Alltag als Routineinstrument eingesetzt [9]. Auch wenn gezeigt werden konnte, dass kein Unterschied der Schmerzeinschätzung zwischen Pflegekräften und Ärzten besteht [10], ist Zeitknappheit in beiden Berufsgruppen ein relevantes Thema.…”

“…Die Schmerzmessung bei Früh-und Neugeborenen erfordert nonverbale Beobachtungsverfahren für den klinischen Alltag als Voraussetzung einer adäquaten Therapie [12]. Hierzu zählen unter anderem das Neonatal Facial Coding System, short version, (NFC-Sshort) und das Premature Infant Pain Profile (PIPP) als etablierte und anerkannte Beobachtungsverfahren mit vergleichbarer psychometrischer Güte [15], die Einsatz im klinischen Alltag finden [5,14,20,23]. In der Anwendung zeichnen sich die einzelnen Beobachtungsverfahren durch eine unterschiedlich gute Praktikabilität aus.…”