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Initial Validation of GRASP: A Differential Diagnoses Algorithm for Children With Medical Complexity and an Unknown
Brenna L Morse1, Jean C Solodiuk2, Christine D Greco2
1Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts; brenna_morse@uml.edu.
Insights
The Guidelines for Ruling Out and Assessing Source of Pain (GRASP) tool shows promise in helping clinicians identify pain sources in children with medical complexity. Initial validation suggests it is clinically effective for guiding evaluations.
Area of Science:
- Pediatric Medicine
- Clinical Assessment Tools
- Pain Management
Background:
- Identifying pain sources in children with medical complexity (MC) presents significant clinical challenges.
- Systematic evaluation is crucial to prevent harm and unnecessary interventions for these patients.
Purpose of the Study:
- To perform the initial validation of the Guidelines for Ruling Out and Assessing Source of Pain (GRASP) tool.
- To assess the GRASP tool's utility in guiding medical evaluations for pain in children with MC.
Main Methods:
- A mixed-methods approach was employed, including expert review, focus groups, and web-based surveys.
- The GRASP tool underwent a trial evaluating its effectiveness in 14 children with MC experiencing pain of unknown origin.
Main Results:
- Clinicians provided feedback supporting the GRASP tool and suggested organizational improvements, such as a flow diagram format.
- Survey participants offered recommendations for enhancing the tool's comprehensiveness.
- The trial indicated the GRASP tool was effective in guiding clinical evaluations for pain in children with MC.
Conclusions:
- Preliminary evidence supports the GRASP tool's content and face validity for evaluating pain sources in children with MC.
- The GRASP tool offers a systematic approach to pain evaluation, aiming to identify the source, prevent harm, and reduce suffering through judicious testing.
Objectives:
Identifying the source of pain for children with medical complexity (MC) is challenging. The purpose of this study was the initial validation of a tool to guide the medical evaluation for identifying the source of pain in children with MC by using differential diagnoses. The tool is entitled Guidelines for Ruling Out and Assessing Source of Pain (GRASP).
Methods:
A mixed-methods approach that included expert review, focus groups, Web-based surveys, and a trial of the GRASP was used to determine validity as well as perceived clinical utility.
Results:
Focus groups were held with 26 inpatient and outpatient clinicians. Participants consistently responded in support of the GRASP. Participants advised several suggestions for tool organization such as designing the tool as a flow diagram. Seven clinicians participated in Web-based surveys and made specific suggestions for making the GRASP more comprehensive. Six participants trialed the GRASP for 14 children with MC and pain of unknown origin. Overall, participants found that the GRASP was a clinically effective tool for guiding medical evaluation.
Conclusions:
These results provide preliminary evidence that the GRASP has content and face validity in evaluating the source of pain in children with MC. This tool can be used to systematically guide clinicians through a balanced approach to evaluation with a goal of determining the pain source, preventing harm, and relieving suffering without unnecessary tests.
