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Individualized Numeric Rating Scale to Assess Pain in Critically Ill Children With Neurodevelopmental Disabilities
Shaneel Rowe1, Kaitlin M Best2
1Shaneel Rowe is a study coordinator, Clinical Research Support Office, Children's Hospital of Philadelphia, Penn-sylvania.
Insights
The Individualized Numeric Rating Scale (INRS) effectively assesses pain in critically ill children with neurodevelopmental disabilities. This tool enhances parent involvement and communication in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental disabilities research
- Pain assessment in vulnerable populations
Background:
- Pain is a significant challenge in children with neurodevelopmental disabilities, often difficult for clinicians to identify.
- Existing pain assessment tools lack validation for pediatric intensive care unit (PICU) settings for this population.
- The Individualized Numeric Rating Scale (INRS) was developed as an adapted 0-10 pain scale incorporating parental input on child pain indicators.
Purpose of the Study:
- To assess the reliability, validity, feasibility, and acceptability of the INRS for pain evaluation in critically ill children with neurodevelopmental disabilities.
- To determine if the INRS can be a reliable tool in the PICU environment.
- To understand parent and nurse perspectives on using the INRS.
Main Methods:
- An observational study using a prospective repeated-measures cohort design in two PICUs.
- Inclusion of critically ill patients aged 3-17 years with neurodevelopmental disabilities.
- Data collection involved structured parent interviews for INRS, bedside nurse INRS assessments, independent research team INRS ratings from video, and feasibility/acceptability surveys for parents and nurses.
Main Results:
- Moderate interrater reliability (weighted κ = 0.56) was found between nurse and research team INRS ratings across 481 paired assessments in 34 patients.
- Parents reported the INRS was easy to create, increased their involvement in care, and improved communication with nurses.
- Feasibility and acceptability data indicated positive parent and nurse experiences.
Conclusions:
- The INRS demonstrates adequate measurement properties for assessing pain in critically ill children with neurodevelopmental disabilities within the PICU.
- The INRS supports patient- and family-centered care goals by facilitating communication and involvement.
- Potential implementation barriers for the INRS should be considered for wider adoption.
Background:
Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with neurodevelopmental disabilities have been validated for use in pediatric intensive care units. The Individualized Numeric Rating Scale (INRS) is an adapted 0-to-10 rating that includes parents' input on their child's pain indicators.
Objectives:
To evaluate the reliability, validity, and feasibility and acceptability of use of the INRS for assessing pain in critically ill children with neurodevelopmental disabilities.
Methods:
This observational study enrolled critically ill patients with neurodevelopmental disabilities aged 3 to 17 years in 2 pediatric intensive care units at a children's hospital using a prospective repeated-measures cohort design. Structured parent interviews were used to populate each patient's INRS. Bedside nurses assessed pain using the INRS throughout the study. The research team completed independent INRS ratings using video clips. Participating parents and nurses completed feasibility and acceptability surveys. Psychometric properties of the INRS and survey responses were evaluated with appropriate statistical methods.
Results:
For 481 paired INRS pain ratings in 34 patients, interrater reliability between nurse and research team ratings was moderate (weighted κ = 0.56). Parents said that creating the INRS was easy, made them feel more involved in care, and helped them communicate with nurses.
Conclusions:
The INRS has adequate measurement properties for assessing pain in critically ill children with neurodevelopmental disabilities. It furthers goals of patient- and family-centered care but may have implementation barriers.
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