Validation of the parent's postoperative pain measure with an age‐appropriate reference pain scale for children 2–12 years old during a 14‐day recovery after tonsillectomy: A prospective cohort study

Abstract

Background: Adenotonsillectomy is associated with severe postoperative pain. The parent's postoperative pain measure (PPPM), a 15-item instrument to measure a child's pain at home, has been validated with a seven-point faces scale in children 7-12 years and with the parents' global report of pain in children 2-6 years.Aims: Our primary objective was to validate the PPPM with a recommended ageappropriate pain scale in children 2-12 years after adenotonsillectomy. Our secondary objective was to reduce the PPPM components and validate this reduced PPPM. Methods: We recruited 319 children out of the 563 adenotonsillectomies performed between December 19, 2017, and December 18, 2018. Parents recorded administration of analgesics and their child's pain scores twice daily for 14 days: PPPM for all children and either the face, legs, arms, crying, consolability (FLACC) pain scale for children 2-3 years or the faces pain scale-revised (FPS-R) for children 4-12 years. In addition, parents recorded analgesics.Results: Among the 354 eligible children, 9% of parents declined. 252 (79%) families submitted pain diaries. The median age was 2.9 [2.5-3.3] years for FLACC (n = 114) and 5.6 [4.5-7.2] years for FPS-R (n = 138). Across the 14-day recovery period, Cronbach's alpha for PPPM was 0.77 to 0.87. Generalized linear mixed models evaluated the association between PPPM and reference pain scales after adjustment for potential confounders. Time of day and postoperative days were included as predictors in the models. PPPM was strongly associated with FLACC and FPS-R (beta coefficient = 0.4; p < 0.0001). The association decreased over time, and the reduction was more significant for FPS-R than FLACC (beta coefficient = −0.13 vs. −0.04, respectively; p < 0.0001). There was a positive association between PPPM and the use of analgesics. A reduction analysis eliminated items from the original PPPM: four for FLACC and five for FPS-R, suggesting age-related differences. The reduced PPPM instruments achieved similar associations with their respective reference pain scales (beta coefficient = 0.5; p < 0.0001).

A service evaluation of the impact of parental information provision on analgesia administration at home posttonsillectomy

“…Parents may be reassured by advice to use a syringe to measure doses more accurately than using a spoon. The addition of a pain scale may help some parents make pain assessments There are several validated pediatric pain assessment tools designed to be used effectively by parents, for example Parents’ Postoperative Pain Measure 26,27 . Providing extra information on morphine in addition to assisting parents with pain assessment utilizing such a tool may assist parental compliance with analgesia.…”

New postoperative pain instrument for toddlers—Secondary analysis of prospectively collected assessments after tonsil surgery

“…After validation of the original PPPM scale and eliminating PPPM items 4, 7, 11, and 15 due to their weak association with the FLACC scale, the resulting shortened form of the PPPM showed similar validation data as the original form. 16 In a second group with older children using the Faces Pain Scale-Revised as a reference scale, the authors excluded other PPPM questions: 5, 9, 10, 11, and 15, 16 which are again other items than in von Baeyer et al, who reduced the PPPM by 5 questions to 10 through excluding the items 2, 8, 11, 13, and 15, thereby developing a 0-10 metric short form. 17 The original PPPM was created for children aged 2 to 12 years old.…”

“…As such, the above-cited studies reduced the PPPM to a sum scale of 10 or 11 items. 16,17 Note: In the bootstrapped analysis, the outcome variable is the indication for rescue medication (CHIPPS ≥4 OR PPPMD ≥6). The Boruta Score estimates the multivariate association between listed variables and the outcome; the minimum score of 0 corresponds to no association, whereas 1 is the maximum association strength and stability.…”

“…Many clinical scores, including pain scales, are created as a sum of items. As such, the above‐cited studies reduced the PPPM to a sum scale of 10 or 11 items 16,17 . However, this approach does not explore multivariate and nonlinear interactions.…”

Reliability and validity of the Dutch version of the Parents’ Postoperative Pain Measure (PPPM-Dv)

“…The reliability and validity of the PPPM was extended to 2-6 year old children showing good internal consistency and good correlations between the PPPM scores and parental global pain ratings in young children (˂6 years).10 Reliability and construct validity is now established beyond fourteen days postoperatively 14 .…”