Disagreement between parents and health professionals regarding pain intensity in critically ill neonates

To verify whether parents and health professionals homogeneously evaluate presence and intensity of neonatal pain. This cross-sectional study enrolled 52 neonates and 154 adults. Inclusion criteria for neonates were admission to neonatal intensive care unit, presence of gastric tube, tracheal tube,...

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Bibliographic Details
Published in:Jornal de pediatria 2008-01, Vol.84 (1), p.35-40
Main Authors: Elias, Luciana S D T, Guinsburg, Ruth, Peres, Clóvis A, Balda, Rita C X, Santos, Amelia M N dos
Format: Article
Language:English
Subjects:
Adult
Cross-Sectional Studies
Dissent and Disputes
Female
Hospitalists
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Interviews as Topic
Male
Nursing Assistants
Observer Variation
Pain - diagnosis
Pain Measurement - statistics & numerical data
Parents
Regression Analysis
Socioeconomic Factors
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Summary:To verify whether parents and health professionals homogeneously evaluate presence and intensity of neonatal pain. This cross-sectional study enrolled 52 neonates and 154 adults. Inclusion criteria for neonates were admission to neonatal intensive care unit, presence of gastric tube, tracheal tube, and venous lines. Each newborn was observed by a different group of three adults (parent, nurse assistant and pediatrician) for 1 minute at the same time to evaluate presence and intensity of infant's pain. Homogeneity of pain evaluation was analyzed by a modified Bland-Altman plot and by intraclass correlation coefficient (ICC). Multiple linear regression analysis was used to evaluate association of neonatal characteristics and heterogeneity of pain scores for adults. ICC showed disagreement of the pain scores given by the three groups of adults (ICC 0.066, agreement > 0.75). Bland-Altman analysis showed agreement among adults when they thought pain was absent. When they thought pain was present, there was heterogeneity of opinions regarding intensity of neonatal pain. Multiple regression analysis indicated that 10% of this disagreement could be explained by infant's gender and mode of delivery. Disagreement among adults about intensity of neonatal pain is a marker of the difficulty in deciding the need for analgesia in preverbal patients.
ISSN:0021-7557
DOI:10.2223/JPED.1748