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Open Access Research article

Identification of pain indicators for infants at risk for neurological impairment: A Delphi consensus study

Bonnie Stevens123*, Patrick McGrath45, Janet Yamada3, Sharyn Gibbins6, Joseph Beyene7, Lynn Breau8, Carol Camfield459, Allen Finley1048, Linda Franck11, Alexandra Howlett5, Celeste Johnston12, Patricia McKeever1, Karel O'Brien13 and Arne Ohlsson13

Author Affiliations

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

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BMC Pediatrics 2006, 6:1  doi:10.1186/1471-2431-6-1

Published: 2 February 2006

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.