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Validity and reliability of a pain location tool for pediatric abdominal surgery
James K Hamill1, Alana M Cole2, Andrew Liley3
1Department of Surgery, University of Auckland, Auckland, New Zealand; Departments of Surgery & Anaesthesia, Starship Children's Hospital, Auckland, New Zealand.
Insights
A new tool, the Location and Level of Intensity of Postoperative Pain (Lolipops) scale, effectively measures pain location in pediatric surgical patients. This valid and reliable tool aids in understanding postoperative pain patterns in children.
Area of Science:
- Pediatric Surgery
- Pain Management
- Clinical Assessment Tools
Background:
- Accurate assessment of postoperative pain location is crucial for children undergoing surgery.
- Existing pain assessment tools may not adequately capture pain localization in pediatric surgical patients.
- The development of specialized tools is needed to improve pain assessment in this population.
Purpose of the Study:
- To develop and validate the Location and Level of Intensity of Postoperative Pain (Lolipops) tool for pediatric surgical patients.
- To assess the reliability and validity of the Lolipops tool in children aged 5-14 years post-laparoscopic appendectomy.
- To evaluate the Lolipops tool's ability to differentiate pain patterns based on surgical diagnosis.
Main Methods:
- The Lolipops tool, comprising a body outline with an abdominal grid and a validated pain scale, was administered to 42 children (5-14 years) post-laparoscopic appendectomy.
- Both nurse- and investigator-administered Lolipops assessments were conducted within 24 hours of surgery.
- The Varni Thompson Pediatric Pain Questionnaire was used as a comparative measure for validity assessment.
Main Results:
- Pain scores were significantly higher at laparoscopic port incision sites compared to distant upper abdominal sites (p < .0001).
- Children with acute appendicitis reported higher pain in the right iliac fossa than in upper abdominal regions (p = .001).
- The Lolipops tool indicated a more widespread pain distribution in children with perforated appendicitis, and fair to moderate inter-rater reliability (ICC=0.597) was observed.
Conclusions:
- The Lolipops tool is a valid and reliable instrument for assessing the location and intensity of postoperative pain in pediatric surgical patients.
- The tool effectively captures localized pain at incision sites and regional pain patterns relevant to specific surgical conditions like appendicitis.
- Lolipops offers a valuable addition to the clinical assessment of pain in children, aiding in targeted pain management strategies.
Abstract:
For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p < .0001). In children with acute appendicitis, pain scores were higher in the right iliac fossa than in upper abdominal sites, mean (SD) 3.3 (2.5) and 0.4 (0.7), respectively (p = .001). In children with perforated appendicitis, Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.
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