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Pain assessment tools for use in infants: a meta-review
Diana Arabiat1,2, Evalotte Mörelius3,4, Kreshnik Hoti5
1Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan. d.arabiat@ecu.edu.au.
Insights
Assessing infant pain is difficult. This review found no perfect tool, highlighting the need for better evidence on pain assessment tools for infants to guide clinical choices.
Area of Science:
- Pediatrics
- Pain Management
- Evidence-Based Practice
Background:
- Infant pain assessment is challenging due to non-verbal communication.
- Reliable and valid pain assessment tools are critical for infant care.
Purpose of the Study:
- To identify evidence guiding the selection of infant pain assessment tools.
- To evaluate psychometric properties of observational pain tools for infants.
Main Methods:
- A meta-review of systematic reviews was conducted.
- Searched multiple databases including Scopus, Medline, and Embase.
- Included reviews documenting psychometric properties of observational infant pain tools.
Main Results:
- 11 systematic reviews and 36 pain assessment tools were identified.
- Evidence for psychometric properties (reliability, validity) varied from low to good.
- Limited data exists on the usability and clinical utility of these tools.
Conclusions:
- No single observer-administered pain tool is currently a gold standard.
- Limited evidence quality hinders definitive recommendations for infant pain assessment tools.
- Standardized evaluation of psychometric properties and clinical utility is needed for tool selection.
Background:
Identifying pain in infants is challenging due to their inability to self-report pain, therefore the availability of valid and reliable means of assessing pain is critical.
Objective:
This meta-review sought to identify evidence that could guide the selection of appropriate tools in this vulnerable population.
Methods:
We searched Scopus, Medline, Embase, CINAHL, MIDRIS, EMCare and Google Scholar for eligible systematic reviews. Eligible reviews documented psychometric properties of available observational tools used to assess pain in infants.
Results:
A total of 516 reviews were identified of which 11 met our inclusion criteria. We identified 36 pain assessment tools (evaluated in 11 reviews) of which seven were reported in at least three reviews. The level of evidence reported on the psychometric properties of pain assessment tools varied widely ranging from low to good reliability and validity, whilst there are limited data on usability and clinical utility.
Conclusions:
Currently, no observer administered pain assessment tool can be recommended as the gold standard due to limited availability and quality of the evidence that supports their validity, reliability and clinical utility. This meta-review attempts to collate the available evidence to assist clinicians to decide on what is the most appropriate tool to use in their clinical practice setting. It is important that researchers adopt a standard approach to evaluating the psychometric properties of pain assessment tools and evaluations of the clinical utility in order that the highest level of evidence can be used to guide tool selection.
