Identification of pain indicators for infants at risk for neurological impairment: A Delphi consensus study
1 Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
2 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
3 Research Institute, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
4 Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
5 Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
6 Interdisciplinary Practice Reseach and Evidence Based Practice, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
7 Statistics in Medicine Unit-Research Institute, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
8 Pediatric Pain Service, IWK Health Centre, Halifax, Nova Scotia, Canada
9 Division of Neurology, IWK Health Centre, Halifax, Nova Scotia, Canada
10 Department of Anesthesiology, Dalhousie University, Halifax, Nova Scotia, Canada
11 Centre for Nursing and Allied Health Professions Research, Great Ormond Street Hospital for Children, London, UK
12 School of Nursing, McGill University, Montreal, Quebec, Canada
13 Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
BMC Pediatrics 2006, 6:1 doi:10.1186/1471-2431-6-1Published: 2 February 2006
A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI.
A 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI.
The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squeeze, and inconsolability. Increased heart rate from baseline in the moderate and severe groups demonstrated high concordance. In the severe risk group, fluctuations in heart rate and reduced oxygen saturation were also highly rated.
These data constitute the first step in contributing to the development and validation of a pain measure for infants at risk for NI. In future research, we will integrate these findings with the opinions of (a) health care providers about the importance and usefulness of infant pain indicators and (b) the pain responses of infants at mild, moderate and high risk for NI.