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Consistency of pediatric pain ratings between dyads: an updated meta-analysis and metaregression
Huaqiong Zhou1,2, Matthew A Albrecht2, Pam A Roberts2
1General Surgical Ward, Perth Children's Hospital, Nedlands, WA, Australia.
Insights
Accurate pediatric pain assessment is difficult for non-verbal children. This study found moderate agreement between child and caregiver pain ratings, but weaker agreement with healthcare providers, highlighting the need for comprehensive pain assessment tools.
Area of Science:
- Pediatric Pain Management
- Clinical Assessment
- Psychometrics
Background:
- Accurate pediatric pain assessment is crucial but challenging, particularly for preverbal children or those with communication barriers.
- Previous meta-analyses indicated moderate correlations in pain ratings between children and caregivers/nurses.
- An updated meta-analysis was conducted to incorporate more recent studies and advanced statistical methods.
Purpose of the Study:
- To update the meta-analysis on pain rating consistency in pediatric populations.
- To examine agreement between children, caregivers, and healthcare providers (HCPs) in assessing pediatric pain.
- To identify factors influencing pain rating consistency.
Main Methods:
- An updated meta-analysis of 40 studies, including 4,628 children, published up to August 8, 2021.
- Inclusion of intraclass correlation/weighted kappa statistics (ICC/WK) alongside standard correlation.
- Metaregression analysis to explore factors associated with pain rating consistency.
Main Results:
- Moderate pain rating consistency was found between children and caregivers (combined 0.55).
- Weaker consistency was observed between children and HCPs (combined 0.45), and between caregivers and HCPs (combined 0.41).
- Factors like recent publication year, caregiver pain assessment tools (e.g., NRS, Wong-Baker, VAS), and surgical pain improved child-caregiver consistency.
Conclusions:
- While child-caregiver agreement is moderate, agreement with HCPs is weaker, indicating a need for improved communication and assessment strategies.
- Surgical pain and specific assessment tools enhance rating consistency.
- Researchers should consider comprehensive pain assessment scales like the Patient-Reported Outcomes Measurement Information System (PROMIS) to capture psychological and psychosocial influences.
Abstract:
Accurate assessment of pediatric pain remains a challenge, especially for children who are preverbal or unable to communicate because of their health condition or a language barrier. A 2008 meta-analysis of 12 studies found a moderate correlation between 3 dyads (child-caregiver, child-nurse, and caregiver-nurse). We updated this meta-analysis, adding papers published up to August 8, 2021, and that included intraclass correlation/weighted kappa statistics (ICC/WK) in addition to standard correlation. Forty studies (4,628 children) were included. Meta-analysis showed moderate pain rating consistency between child and caregiver (ICC/WK = 0.51 [0.39-0.63], correlation = 0.59 [0.52-0.65], combined = 0.55 [0.48-0.62]), and weaker consistency between child and health care provider (HCP) (ICC/WK = 0.38 [0.19-0.58], correlation = 0.49 [0.34-0.55], combined = 0.45; 95% confidence interval 0.34-0.55), and between caregiver and HCP (ICC/WK = 0.27 [-0.06 to 0.61], correlation = 0.49 [0.32 to 0.59], combined = 0.41; 95% confidence interval 0.22-0.59). There was significant heterogeneity across studies for all analyses. Metaregression revealed that recent years of publication, the pain assessment tool used by caregivers (eg, Numerical Rating Scale, Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale), and surgically related pain were each associated with greater consistency in pain ratings between child and caregiver. Pain caused by surgery was also associated with improved rating consistency between the child and HCP. This updated meta-analysis warrants pediatric pain assessment researchers to apply a comprehensive pain assessment scale Patient-Reported Outcomes Measurement Information System to acknowledge psychological and psychosocial influence on pain ratings.
