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Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants
T Debillon1, V Zupan, N Ravault
1Neonatal Intensive Care Unit, Mother-Child University Hospital, 44 093 Nantes Cedex 01, France. thierry.debillon@chu-nantes.fr
Insights
The EDIN scale effectively assesses prolonged pain in premature infants using behavioral indicators. This validated tool aids clinical practice in identifying and managing infant discomfort.
Area of Science:
- Neonatal care
- Pediatric pain assessment
- Psychometrics
Background:
- Assessing pain in preterm infants is challenging due to communication limitations.
- Prolonged pain requires reliable measurement tools for effective clinical management.
Purpose of the Study:
- To develop and validate the EDIN scale (Echelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) for assessing prolonged pain in preterm infants.
- To establish the scale's suitability for clinical practice.
Main Methods:
- The EDIN scale was developed using expert-selected behavioral pain indicators observed in preterm infants.
- A prospective cohort study of 76 preterm infants assessed construct validity, inter-rater reliability, and internal consistency.
Main Results:
- The EDIN scale comprises five behavioral indicators: facial activity, body movements, sleep quality, nurse interaction, and consolability.
- Acceptable inter-rater reliability (kappa 0.59-0.74) and high internal consistency (Cronbach's alpha 0.86-0.94) were demonstrated.
- Significant differences in EDIN scores between pain and no-pain situations confirmed construct validity.
Conclusions:
- The EDIN scale is a validated tool appropriate for assessing prolonged pain in preterm infants in clinical settings.
- Further research is recommended to strengthen construct validity in less extreme pain scenarios.
Objective:
To develop and validate a scale suitable for use in clinical practice as a tool for assessing prolonged pain in premature infants.
Methods:
Pain indicators identified by observation of preterm infants and selected by a panel of experts were used to develop the EDIN scale (Echelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale). A cohort of preterm infants was studied prospectively to determine construct validity, inter-rater reliability, and internal consistency of the scale.
Results:
The EDIN scale uses five behavioural indicators of prolonged pain: facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability. The validation study included 76 preterm infants with a mean gestational age of 31.5 weeks. Inter-rater reliability was acceptable, with a kappa coefficient range of 0.59-0.74. Internal consistency was high: Cronbach's alpha coefficients calculated after deleting each item ranged from 0.86 to 0.94. To establish construct validity, EDIN scores in two extreme situations (pain and no pain) were compared, and a significant difference was observed.
Conclusions:
The validation data suggest that the EDIN is appropriate for assessing prolonged pain in preterm infants. Further studies are warranted to obtain further evidence of construct validity by comparing scores in less extreme situations.