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Accuracy of parental-global-impression of children's acute pain
Rachel Yaffa Zisk1, Margaret Grey, Barbara Medoff-Cooper
1Yale University School of Nursing, New Haven, CT, USA. rachelzisk@yahoo.com
Insights
Parental global impression effectively assesses children's acute pain at home, showing good sensitivity and specificity compared to child self-reports. It serves as a valuable supplementary tool for pain measurement.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Child Psychology
Background:
- Accurate assessment of acute pain in children is crucial for effective treatment.
- Parental perception of pain can differ from a child's self-report.
- Validated instruments are needed to support parental pain assessment.
Purpose of the Study:
- To compare parental global impression of pain with children's self-reports and a structured parental pain measure.
- To evaluate the accuracy of parental pain assessment in children with fractured limbs.
- To determine the utility of parental global impression as an adjunct pain assessment tool.
Main Methods:
- Recruited 32 parents of children (5-10 years) with fractured limbs treated in a tertiary emergency department.
- Utilized three home-based assessments: parental global impression, child's reported pain, and Parental Postoperative Pain Measure.
- Analyzed data using odds ratios, sensitivity, specificity, predictive values, and repeated-measures ANOVA.
Main Results:
- Parental global impression demonstrated high sensitivity (76% day 1, 93% day 2) and specificity (91% day 1, 83% day 2) compared to child self-report.
- The Parental Postoperative Pain Measure showed lower sensitivity (71% day 1, 66% day 2) and comparable specificity (82% day 1, 83% day 2).
- Parental global impression met acceptable statistical criteria for accuracy.
Conclusions:
- Parental global impression is a sensitive and specific tool for assessing children's acute pain at home.
- It can be used as an adjunct measure alongside child self-reports.
- Parental global impression should not replace direct child pain reporting but can enhance assessment when needed.
Abstract:
The primary purpose of this study is to compare parental-global-impression of children's level of acute pain at home with parental assessment of children's pain using a structured instrument and with children's self-reports of pain. We recruited 32 parents of children aged 5 to 10 years who were diagnosed with a fractured limb and treated in a tertiary emergency department. After discharge, parents were asked to complete three home-based assessments relating to their child's acute pain: the parental-global-impression of pain, child's reported pain, and structured Parental Postoperative Pain Measure. Data analysis included odds ratios, sensitivity, specificity, positive and negative predictive values, and repeated-measures analysis of variance. When compared with child report of pain, the sensitivity of parental-global-impression was 76% on day 1 and 93% on day 2, whereas specificity was 91% on day 1 and 83% on day 2. When compared with child report of pain, the sensitivity of Parental Postoperative Pain Measure was 71% on day 1 and 66% on day 2, whereas specificity was 82% on day 1 and 83% on day 2. On the basis of acceptable statistical criteria, parental-global-impression has good sensitivity and specificity compared with the child self-report measure. We do not suggest, however, that parental-global-impression can or should replace child report, but rather suggest that it can be used as an adjunct assessment measure as needed.
