Parallel assessment of prolonged neonatal distress by empathy-based and item-based scales

Area of Science:

• Neonatal care
• Pain assessment
• Psychometrics

Background:

• Assessing pain and distress in neonates is crucial for optimal care.
• Existing pain scales vary in their approach, including empathy-based and item-based methods.
• The Faces Pain Scale-Revised (FPS-R) and Neonatal Pain, Agitation and Sedation Scale (N-PASS) are commonly used but their comparative performance in prolonged distress assessments is not fully understood.

Purpose of the Study:

• To evaluate the association between the empathy-based FPS-R and the item-based N-PASS for assessing prolonged distress in term and preterm infants.
• To determine the psychometric properties and agreement between these scales over a 48-hour period.

Main Methods:

• A sequential prospective psychometric evaluation was conducted over 48 hours at 4-hour intervals.
• The FPS-R and N-PASS were used in parallel by nurses to assess distress in 44 term and preterm infants.
• Correlation and agreement rates between the two scales were analyzed over different time intervals.

Main Results:

• While the median FPS-R score significantly declined over 48 hours, the N-PASS score did not change significantly.
• A strong correlation between FPS-R and N-PASS was observed in the first 12 hours, which progressively decreased but remained significant throughout the 48-hour period.
• The agreement rate between FPS-R and N-PASS in categorizing infants as distressed or not remained stable, ranging from 79.6% to 89.4%.

Conclusions:

• There is a progressive divergence between FPS-R and N-PASS scores when assessing neonates over 48 hours.
• Despite score divergence, the stable agreement in distress categorization supports the potential use of FPS-R in neonatal care.
• The choice between item-based and empathy-based pain assessment scales may depend on individual preferences rather than solely on scientific evidence.