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Validation of the premature infant pain profile in the clinical setting
M Ballantyne1, B Stevens, M McAllister
1The Hospital for Sick Children, Toronto, Ontario, Canada. marilyn.ballantyne@sick-kids.on.ca
Insights
The Premature Infant Pain Profile (PIPP) accurately assesses pain in neonates, showing strong validity and reliability in clinical settings. This tool helps healthcare providers better manage infant pain.
Area of Science:
- Neonatal care
- Pain assessment
- Pediatric research
Background:
- The Premature Infant Pain Profile (PIPP) is a validated tool for assessing acute pain in neonates.
- Previous validation involved synchronized videotaping during procedures.
- Prospective clinical validation was needed.
Purpose of the Study:
- To establish the construct validity of the PIPP.
- To determine the interrater reliability of the PIPP.
- To determine the intrarater reliability of the PIPP in a clinical setting.
Main Methods:
- A randomized, crossover design was employed in a Level III neonatal intensive care unit.
- 43 neonates, stratified by gestational age, participated.
- Infants underwent baseline, painful, and non-painful events, with bedside and expert video scoring using the PIPP.
Main Results:
- The PIPP demonstrated statistically significant differentiation between pain, non-pain, and baseline events (F = 48, p = 0.0001), confirming construct validity.
- Interrater reliability coefficients for PIPP scores ranged from 0.93 to 0.96.
- Intrarater reliability coefficients for PIPP scores were high, ranging from 0.94 to 0.98.
Conclusions:
- The PIPP is a reliable and valid measure for assessing procedural pain in preterm and term infants.
- The study confirms the PIPP's utility in clinical settings.
- High inter- and intrarater reliability support consistent PIPP application by healthcare professionals.
Objective:
The Premature Infant Pain Profile (PIPP) is a 7-indicator composite measure developed to assess acute pain in preterm and term neonates. It has been validated in studies using synchronized videotaping of infants undergoing procedures. The purpose of this study was to establish (a) construct validity of the PIPP and (b) inter- and intrarater reliability of the PIPP prospectively in the clinical environment.
Design:
A randomized, crossover design was used.
Setting:
The study was conducted in a Level III outborn neonatal intensive care unit.
Participants:
A convenience sample of 43 neonates, stratified by gestational age, was studied.
Interventions:
Each infant experienced three separate, randomly ordered events: baseline, a painful event, and a nonpain event. Infants were videotaped and scored at the bedside using the PIPP by the nurse caring for the infant and the clinical nurse specialist who bad expertise in infant pain. The videotapes were later reviewed by two additional experts; one in real time and one using a second-to-second stop frame technique.
Results:
Repeated-measures analysis of the main effects and interactions yielded a statistically significant main effect for event (pain, nonpain, baseline), thus differentiating pain from nonpain and baseline events (F = 48, p = 0.0001) and establishing construct validity. Interrater reliability analysis of individual event scores of the PIPP yielded reliability coefficients of 0.93-0.96. Intrarater reliability coefficients analysis for individual events were equally high at 0.94-0.98.
Conclusions:
This study demonstrates that the PIPP is a pain measure with good construct validity and excellent inter- and intrarater reliability for the assessment of procedural pain of preterm and term infants in clinical settings.