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Pain indicators for persisting pain in hospitalized infants in a South African setting: an explorative study
Insights
This study validated the Touch Visual Pain (TVP) scale for assessing persistent pain in hospitalized infants in South Africa. The revised TVP scale shows promise for clinical use in young children experiencing pain.
Area of Science:
- Pediatrics
- Pain Management
- Clinical Assessment
Background:
- Infants in developing nations face high rates of inflammatory diseases, increasing the risk of persistent pain.
- Accurate pain assessment in non-verbal infants is crucial for effective management.
Purpose of the Study:
- To evaluate the reliability and validity of the Touch Visual Pain (TVP) scale for measuring persistent pain in hospitalized infants.
- To identify behavioral indicators sensitive to pain and distress in young children.
Main Methods:
- A prospective observational study involving 151 hospitalized infants (0-3 years) in South Africa.
- Comparison of the TVP scale with Numeric Rating Scale (NRS) for pain and distress.
- Logistic regression analysis to assess associations between TVP items and NRS scores.
Main Results:
- 337 assessments were analyzed, with significant pain (NRS ≥ 4) in 24% and distress (NRS ≥ 4) in 72% of cases.
- Four TVP items correlated significantly with NRS pain; three with NRS distress.
- Behaviors like "cry/moaning" and "alertness" were linked to distress; two TVP items were revised for improved sensitivity.
Conclusions:
- The study identified sensitive and specific behavioral indicators for persistent pain in hospitalized South African infants under three years old.
- A revised TVP scale emerged, requiring further psychometric validation before widespread clinical recommendation.
Abstract:
In the developing world, there is a high incidence of human immunodeficiency virus (HIV), gastroenteritis, pneumonia, meningitis, and other inflammatory diseases in infants, the conditions of which may induce persisting pain. The primary objective was to estimate the reliability and validity of the Touch Visual Pain (TVP) scale to measure persisting pain. This prospective observational study was performed in hospitalized 0-3-year-old infants in South Africa. The Numeric Rating Scale (NRS) pain, NRS distress, and the TVP scale were applied and scores were compared. The TVP scale consists of 10 behavioral indicators scored as present or not present. Associations between the different scales were tested with logistic regression analyses. We analyzed 337 assessments in 151 patients. The NRS pain score was 4 or higher in 82 (24%) assessments. The NRS distress score was 4 or higher in 242 (72%) assessments. The mean TVP score was 3.7 (SD = 1.6). Four TVP items were statistically significantly associated with NRS pain; three other TVP items with NRS distress. The behaviors "cry/moaning" and "alertness" were also significantly associated with NRS distress. Two TVP items were not sensitive to assess pain or distress and were replaced in a revised TVP version. We conclude that our study identified sensitive and specific indicators of persisting pain in hospitalized children under the age of 3 years in a South African setting. Psychometric properties of the revised TVP need to be studied before its use in clinical practice can be recommended.
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