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A revised measure of acute pain in infants
A Taddio1, I Nulman, B S Koren
1Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
A modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) effectively assessed infant pain during immunizations. The local anesthetic cream Eutectic Mixture of Local Anesthetics (EMLA) significantly reduced infant pain scores.
Area of Science:
- Pediatrics
- Pain Management
- Psychology
Background:
- Optimal assessment and management of acute pain in infants remain challenging.
- Behavioral pain assessment tools are crucial for understanding infant pain experiences.
Purpose of the Study:
- To adapt the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for infant pain assessment.
- To establish the reliability and validity of the adapted CHEOPS in infants undergoing immunization.
Main Methods:
- Ninety-six infants (4-6 months) received either Eutectic Mixture of Local Anesthetics (EMLA) or placebo before immunization.
- Infant behavior was videotaped pre- and post-immunization for pain score assessment.
- Interrater reliability was assessed by five independent raters on ten infants.
Main Results:
- Infants receiving EMLA demonstrated significantly lower postprocedural pain scores (P=0.01).
- Pain scores showed significant correlation with visual analogue scale (VAS) scores.
- High interrater reliability was observed (intraclass correlation coefficient = 0.95).
Conclusions:
- The adapted CHEOPS shows initial construct and concurrent validity and interrater reliability in a research setting.
- Further validation in clinical settings is recommended for the infant pain assessment measure.
Abstract:
Acute pain in infants is not assessed or managed optimally. The objectives of the study were (a) to adapt a behavioral pain assessment measure (Children's Hospital of Eastern Ontario Pain Scale, CHEOPS) for use with infants, and (b) to establish the reliability and validity of the measure in a study of infants undergoing immunization. Ninety-six healthy 4- to 6-month-old infants were randomized to receive either the local anesthetic cream Eutectic Mixture of Local Anesthetics (EMLA) (N = 49), or a placebo (N = 47) prior to immunization. The infant's behavioral response was videotaped immediately before and following the immunization. Postprocedural pain scores were assessed from the videotape and were significantly lower in infants who received EMLA (P = 0.01). Pain scores were also significantly correlated with visual analogue scale (VAS) scores assessed during vaccination. Five independent raters also independently rated ten infants to determine interrater reliability. Agreement between raters' scores was high (intraclass correlation coefficient, 0.95). Results from this study suggest that this measure has beginning construct and concurrent validity and interrater reliability when used in a research study. Further testing of the measure in the clinical setting is required.