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Lin N, Lv M, Li S, Xiang Y, Li J, Xu H. A nomogram for predicting postoperative delirium in pediatric patients following cardiopulmonary bypass: A prospective observational study. Intensive Crit Care Nurs 2024; 83:103717. [PMID: 38692080 DOI: 10.1016/j.iccn.2024.103717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To create a nomogram for early delirium detection in pediatric patients following cardiopulmonary bypass. RESEARCH METHODOLOGY/DESIGN This prospective, observational study was conducted in the Cardiac Intensive Care Unit at a Children's Hospital, enrolling 501 pediatric patients from February 2022 to January 2023. Perioperative data were systematically collected through the hospital information system. Postoperative delirium was assessed using the Cornell Assessment of Pediatric Delirium (CAPD). For model development, Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to identify the most relevant predictors. These selected predictors were then incorporated into a multivariable logistic regression model to construct the predictive nomogram. The performance of the model was evaluated by Harrell's concordance index, receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. External validity of the model was confirmed through the C-index and calibration plots. RESULTS Five independent predictors were identified: age, SpO2 levels, lymphocyte count, diuretic use, and midazolam administration, integrated into a predictive nomogram. This nomogram demonstrated strong predictive capacity (AUC 0.816, concordance index 0.815) with good model fit (Hosmer-Lemeshow test p = 0.826) and high accuracy. Decision curve analysis showed a significant net benefit, and external validation confirmed the nomogram's reliability. CONCLUSIONS The study successfully developed a precise and effective nomogram for identifying pediatric patients at high risk of post-cardiopulmonary bypass delirium, incorporating age, SpO2 levels, lymphocyte counts, diuretic use, and midazolam medication. IMPLICATIONS FOR CLINICAL PRACTICE This nomogram aids early delirium detection and prevention in critically ill children, improving clinical decisions and treatment optimization. It enables precise monitoring and tailored medication strategies, significantly contributes to reducing the incidence of delirium, thereby enhancing the overall quality of patient care.
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Affiliation(s)
- Nan Lin
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Meng Lv
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Shujun Li
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yujun Xiang
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Jiahuan Li
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Hongzhen Xu
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
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Fu CH, Li Y, Zhang YC, Yang XY, Liu J, Ju MJ, Xu TT. Nursing Care of a Child With Delirium Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Case Report. Crit Care Nurse 2024; 44:13-20. [PMID: 38555967 DOI: 10.4037/ccn2024150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Children receiving extracorporeal membrane oxygenation are prone to delirium. This case report describes the nursing care of a child with delirium who received venoarterial extracorporeal membrane oxygenation. Relevant interventions and precautions are also discussed. CLINICAL FINDINGS A 6-year-old girl was admitted to the pediatric intensive care unit with a 2-day history of vomiting and fever. The child underwent cannulation for venoarterial extracorporeal membrane oxygenation. DIAGNOSIS The child was diagnosed with acute fulminant myocarditis, cardiac shock, and ventricular arrhythmia. INTERVENTIONS On the third day of extracorporeal membrane oxygenation, bedside nurses began using the Cornell Assessment of Pediatric Delirium to assess the child for delirium symptoms. The team of physicians and nurses incorporated a nonpharmacologic delirium management bundle into pediatric daily care. Delirium screening, analgesia and sedation management, sleep promotion, and family participation were implemented. OUTCOMES During the 18 days of pediatric intensive care unit hospitalization, the child had 6 days of delirium: 1.5 days of hypoactive delirium, 1.5 days of hyperactive delirium, and 3 days of mixed delirium. The child was successfully discharged home on hospital day 22. CONCLUSION Caring for a child with delirium receiving venoarterial extracorporeal membrane oxygenation required multidimensional nursing capabilities to prevent and reduce delirium while ensuring safe extracorporeal membrane oxygenation. This report may assist critical care nurses caring for children under similar circumstances.
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Affiliation(s)
- Cong-Hui Fu
- Cong-hui Fu is a clinical nurse in the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Yan Li is a clinical nurse in the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Yu-Cai Zhang
- Yu-cai Zhang is the Unit Director of the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Xiao-Ya Yang
- Xiao-ya Yang is a clinical nurse in the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Ji Liu
- Ji Liu is a clinical nurse in the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Min-Jie Ju
- Min-jie Ju is a clinical nurse in the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Ting-Ting Xu
- Ting-ting Xu is a superintendent nurse in the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine
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Ng SLA, Leow XRG, Ang WW, Lau Y. Effectiveness of near-infrared light devices for peripheral intravenous cannulation in children and adolescents: A meta-analysis of randomized controlled trials. J Pediatr Nurs 2024; 75:e81-e92. [PMID: 38195374 DOI: 10.1016/j.pedn.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To examine the effectiveness of near-infrared light devices (NIR) on procedure time of successful cannulation, success rate at the first attempt, and pain scores among pediatric patients and explore potential covariates on the intervention effect. BACKGROUND Pediatric patients have encountered a high failure rate as compared with adult patients using traditional cannulation. NIR devices might help to access veins with an optimum viewing area and eliminate the number of attempts. However, methodological limitations and inconsistent results from previous reviews were found. METHODS A three-step comprehensive search was performed in nine databases. Meta-analysis, subgroup, and meta-regression analyses were conducted. Individual quality assessment and certainty of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations, Assessments, Development, and Evaluation criteria, respectively. RESULTS We included 18 randomized controlled trials (RCTs) with 5298 children and adolescents across nine countries. NIR light devices significantly reduce -29.43 s of procedure time and -0.47 attempts of peripheral intravenous cannulation compared with traditional methods. Subgroup analysis observed a significantly large effect size on procedure time using AccuVein with pre-procedure training at the clinics. However, NIR light devices do not significantly decrease the procedure time, first attempt success rate, and pain scores. Meta-regression identified sample size as a significant covariate that had an impact on the success rate at the first attempt. CONCLUSIONS The near-infrared light device can statistically significantly reduce the procedure time and the number of attempts. Given the low or very low certainty of the evidence, future well-designed RCTs are necessary.
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Affiliation(s)
- Si Li Annalyn Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Xin Rong Gladys Leow
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Wen Wei Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ying Lau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Yu Z, Zhou Y, Xu X, Lin L, Le Q, Gu Y. Pharmacological and non-pharmacological interventions in management of peripheral venipuncture-related pain: a randomized clinical trial. BMC Pediatr 2023; 23:58. [PMID: 36737707 PMCID: PMC9896864 DOI: 10.1186/s12887-023-03855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Venipuncture is a routine nursing procedure in the pediatric ward for blood collection and transfusion. However, this procedure can cause severe pain and distress if not adequately managed. METHODS Children aged 3-16 years old were randomized into three groups: EMLA group, distraction group, and combined group. The primary outcome was children's self-reported pain scored using the Wong-Baker FACES® Pain Rating Scale. The parents-reported and observer-reported pain were scored using the Revised Face, Legs, Activity, Cry and Consolability Scale, and children's salivary cortisol levels, heart rate, percutaneous oxygen saturation, venipuncture duration and retaining time of IV cannulas were the secondary outcomes. RESULTS A total of 299 children (167 male, 55.8%, median age 8.5) were enrolled: EMLA group (n = 103), distraction group(n = 96) and combined group(n = 100). There was no statistical difference in self-reported pain (P = 0.051), parent-reported pain (P = 0.072), and observer-reported pain (P = 0.906) among the three groups. All three interventions can decrease children's pain during IV cannulations. Additionally, the distraction group's salivary cortisol levels were lower than the combined group(P = 0.013). Furthermore, no significant difference was observed in the heart rate(P = 0.844), percutaneous oxygen saturation (P = 0.438), venipuncture duration (p = 0.440) and retaining time of IV cannulas (p = 0.843) among the three groups. CONCLUSIONS All three groups responded with slight pain during the peripheral venipuncture procedure. Therefore, medical workers in pediatric settings can use the interventions appropriate for their medical resources and availability while involving parents and children's preferences whenever possible. TRIAL REGISTRATION This trial was registered on https://register. CLINICALTRIALS gov/ (Gov.ID NCT04275336).
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Affiliation(s)
- Zhuowen Yu
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, No. 399, Wanyuan Rd, Minhang District, Shanghai, China
| | - Yiwen Zhou
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, No. 399, Wanyuan Rd, Minhang District, Shanghai, China
| | - Xiaofeng Xu
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, No. 399, Wanyuan Rd, Minhang District, Shanghai, China
| | - Lili Lin
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, No. 399, Wanyuan Rd, Minhang District, Shanghai, China
| | - Qian Le
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, No. 399, Wanyuan Rd, Minhang District, Shanghai, China
| | - Ying Gu
- Children's Hospital of Fudan University, No. 399, Wanyuan Rd, Minhang District, Shanghai, China.
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Peng T, Qu S, Du Z, Chen Z, Xiao T, Chen R. A Systematic Review of the Measurement Properties of Face, Legs, Activity, Cry and Consolability Scale for Pediatric Pain Assessment. J Pain Res 2023; 16:1185-1196. [PMID: 37064956 PMCID: PMC10094406 DOI: 10.2147/jpr.s397064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
Purpose We performed this systematic review to summarize the psychometric properties of Face, Legs, Activity, Cry and Consolability (FLACC) scale in pediatric patients in different settings. Methods Two investigators independently searched PubMed, EMBASE, OVID and China National Knowledge Infrastructure (CNKI) for eligible studies through July 2021. We assessed the psychometric properties using the modified critical appraisal tool (CAT). Finally, we systematically reviewed the results of the included studies. Results A total of 15 studies were eventually included. The overall quality of each eligible study was low to moderate. The FLACC scale has been available in different versions and in different settings. Although eligible studies have demonstrated significant clinical benefit in assessing postoperative pain in pediatric patients aged 0 to 10 years from post-anesthetic care unit (PACU), pediatric intensive care unit (PICU) and inpatient unit, and in assessing procedural pain in pediatric patients aged 0.5 to 7 years from emergency unit, immunization center and PICU, mostly without test-retest analysis. Conclusion Although the absence of a gold standard of pain assessment, the currently available data support the usefulness of the FLACC from the perspective of criterion validity. Therefore, the FLACC scale can be considered for measuring observational pain in infants and children. However, further studies are still needed to provide more robust evidence.
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Affiliation(s)
- Tuochao Peng
- Department of Anesthesia and Surgery, Hunan Children’s Hospital, Changsha, 410007, People’s Republic of China
- Correspondence: Tuochao Peng, Department of Anesthesia and Surgery, Hunan Children’s Hospital, Changsha, 410007, People’s Republic of China, Tel +86 13755074295, Email
| | - Shuangquan Qu
- Department of Anesthesia and Surgery, Hunan Children’s Hospital, Changsha, 410007, People’s Republic of China
| | - Zhen Du
- Department of Anesthesia and Surgery, Hunan Children’s Hospital, Changsha, 410007, People’s Republic of China
| | - Zheng Chen
- Department of Anesthesia and Surgery, Hunan Children’s Hospital, Changsha, 410007, People’s Republic of China
| | - Ting Xiao
- Department of Anesthesia and Surgery, Hunan Children’s Hospital, Changsha, 410007, People’s Republic of China
| | - Ru Chen
- Department of Anesthesia and Surgery, Hunan Children’s Hospital, Changsha, 410007, People’s Republic of China
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Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline. Cardiol Young 2022; 32:1881-1893. [PMID: 36382361 DOI: 10.1017/s1047951122003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline. METHODS A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus. RESULTS 60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations. CONCLUSIONS Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.
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Mauritz MD, Uhlenberg F, Dreier LA, Giordano V, Deindl P. Discriminant properties of the Behavioral Pain Scale for assessment of procedural pain-related distress in ventilated children. Scand J Pain 2022; 22:464-472. [PMID: 35451587 DOI: 10.1515/sjpain-2021-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/01/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Children hospitalized in a pediatric intensive care unit (PICU) are frequently exposed to distressing and painful medical procedures and interventions. There is a lack of clinical scales to measure procedural pain-related distress in ventilated children. The Behavioral Pain Scale (BPS) was initially developed to detect procedural pain in critically ill adults. This study aims to assess the BPS's discriminant properties for measuring procedural pain-related distress in ventilated pediatric patients incorporating two instruments validated for pediatric patients. METHODS This prospective exploratory study was performed with ventilated children admitted to the interdisciplinary 14-bed PICU of the University Children's Hospital, University Medical Center Hamburg-Eppendorf, Germany. The nurse in charge and an independent observer simultaneously assessed the patients using German versions of the BPS, the COMFORT-B scale (CBS), and the modified Face, Legs, Activity, Cry, Consolability (mFLACC) scale immediately before and during endotracheal suctioning. RESULTS We analyzed 170 parallel assessments in n=34 ventilated children. Patients were (mean ± SD) 9.5 ± 4.8 years old. Internal consistency for the BPS was excellent (α=0.93). We found a high rater agreement for all clinical scales (BPS: k=0.73, CBS: k=0.80, mFLACC: k=0.71). Strong correlations were identified between BPS and CBS (r=0.89) and BPS and mFLACC (r=0.79). The BPS cutoff values showed likewise excellent results (area under the curve CBS >16: 0.97; mFLACC >2: 0.91). CONCLUSIONS In our population of ventilated children, the BPS was well suited to detect procedural pain-related distress compared with two validated pain scales. Further extensive validation studies should follow to support our findings.
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Affiliation(s)
- Maximilian David Mauritz
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Uhlenberg
- Department of Pediatrics and Adolescent Medicine, Neonatology and Pediatric Intensive Care Medicine, Itzehoe Medical Center, Itzehoe, Germany
| | | | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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van der Heijden MJE, O’Flaherty L, van Rosmalen J, de Vos S, McCulloch M, van Dijk M. Aromatherapy massage seems effective in critically ill children: an observational before-after study. PAEDIATRIC & NEONATAL PAIN 2022; 4:61-68. [PMID: 35719220 PMCID: PMC9189908 DOI: 10.1002/pne2.12073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Children treated in a pediatric intensive care unit (PICU) are at risk of distress and pain. This study investigated if aromatherapy massage can reduce children's distress and improve comfort. This observational before-after study was performed in a 22-bed PICU in Cape Town, South Africa. The aromatherapy massage consisted of soft massaging using the "M-technique" and a 1% blend of essential oils of Lavender (Lavandula angustifolia), German Chamomile (Matricatia recutita) and Neroli (Citrus aurantium) mixed with a grapeseed carrier oil. All present children were eligible, except those who had recently returned, were asleep or deemed unstable. The primary outcome was distress measured with the COMFORT-Behavior scale (COMFORT-B). Secondary outcomes were heart rate, oxygen saturation (SatO2), the Numeric Rating Scale (NRS)-Anxiety and pain assessed by the NRS-Pain scale. Outcomes variables were evaluated with Wilcoxon signed-rank test and multiple regression analysis. The intervention was applied to 111 children, fifty-one of whom (45.9%) were younger than three years old. The group median COMFORT-B score before intervention was 15 (IQR 12-19), versus 10 (IQR 6-14) after intervention. Heart rate and NRS-Anxiety were significantly lower after the intervention (P < 0.001). Multiple regression analysis showed that interrupted massages were less effective than the uninterrupted massages. Parental presence did not influence the outcome variables. We did not find a significant change on the NRS-Pain scale or for SatO2. Aromatherapy massage appears beneficial in reducing distress, as measured by the COMFORT-B scale, heart rate and the NRS-Anxiety scale, in critically ill children. Thus, the potential of aromatherapy in clinical practice deserves further consideration.
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Affiliation(s)
- Marianne J. E. van der Heijden
- Department of Internal Medicine and Department of Paediatric SurgeryErasmus MC Sophia Children’s HospitalRotterdamthe Netherlands
| | - Linda‐Anne O’Flaherty
- Division of Pain ManagementRed Cross War Memorial Children’s HospitalCape TownSouth Africa
| | | | - Simone de Vos
- Department of Paediatric SurgeryErasmus MC‐Sophia Children’s HospitalRotterdamthe Netherlands
| | - Mignon McCulloch
- Division of Paediatric NephrologyRed Cross War Memorial Children’s HospitalCape TownSouth Africa
| | - Monique van Dijk
- Department of Internal Medicine and Department of Paediatric SurgeryErasmus MC Sophia Children’s HospitalRotterdamthe Netherlands
- Department of Paediatric SurgeryRed Cross Children’s HospitalCape TownSouth Africa
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Tasman SGR, Putri FA, Maulina T. Validation of the Indonesian Version of the Face, Legs, Activity, Cry, Consolability (FLACC) Scale in Postoperative Cleft Lip and/or Cleft Palate Patients. Open Dent J 2022. [DOI: 10.2174/18742106-v15-e2202090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The face, leg, activity, cry, and consolability (FLACC) scale is a validated pain measurement instrument that is used on postoperative patients with limited verbal ability, including postoperative cleft lip and/or cleft palate patients.
Objective:
This research aimed to test the validity and reliability of the Indonesian version of the FLACC scale as a measuring instrument for pain intensity experienced by postoperative cleft lip and/or cleft palate patients.
Methods:
The procedure was initiated by a back-translation process of the FLACC. Once the back-translation process is completed, a calibration process of the field researchers was conducted. Twenty-eight participants that went through a cleft lip and/or cleft palate surgery at the Unpad Dental Hospital were then enrolled. Two calibrated field researchers measured the postoperative pain intensity in three different time points, shortly after the patients regained full consciousness (T0), four hours (T1), and eight hours after the first measurement (T2). The collected data were analysed by SPSS version 23. The Spearman correlation analysis was performed to test the validity, while a Cronbach’s alpha value was calculated to test the reliability.
Results:
Based on the results of the Spearman correlation analysis, the Indonesian version of the FLACC scale was considered to be valid as the r values of each sub-scale were all higher than the r table value (r value > 0.317). Reliability was marked by the obtained Cronbach’s alpha value of 0,875.
Conclusion:
The Indonesian version of the FLACC scale was considered to be valid and reliable to be used as a pain measurement tool in postoperative cleft lip and/or cleft palate patients.
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Matula ST, Irving SY, Deatrick JA, Steenhoff AP, Polomano RC. The Prevalence, Intensity, Assessment, and Management of Acute Pain in Hospitalized Children in Botswana. Pain Manag Nurs 2022; 23:548-558. [PMID: 34987004 DOI: 10.1016/j.pmn.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is very limited clinical and observational data on acute pain experienced by children in sub-Saharan Africa. AIMS To report the prevalence and intensity of acute pain, pain management practices, and describe associations between acute pain outcomes, children's and parents or guardian's demographics in hospitalized children aged 2 months to 13 years in Botswana. DESIGN A descriptive correlational prospective observational study using five repeated cross-sectional samples. SETTINGS Two referral hospitals in Botswana. PARTICIPANTS The sample size included 308 children and 226 parents or guardians. Data were collected between November 2018 and February 2019 from children, their parents or guardians (<7 years child), and the health record for pain documentation and treatment. MEASURES Pain was measured using Faces Pain Scale-Revised for children ≥7 years, revised Face, Legs, Activity, Cry, Consolability scale for children <7 years and numeric rating scale for parents or guardians. RESULTS There are 1,290 data points for children of which 1,000 were children <7 years and 999 data points for parents or guardians of children <7 years were used in analysis. Fifty percent of children <7 years were in pain using the revised Face, Legs, Activity, Cry, Consolability scale, whereas parents indicated 46% to be in pain. The pain prevalence for children ≥7 years was estimated at 54%. Pain was documentated at a rate of 54 % on the health records. Acetaminophen was most common analgesic across all age groups. Univariate associations of child <7 years pain intensity was statistically significant (p ≤ .05) for weight, diagnosis, residence, and parent relationship. Parents reported pain intensity was statistically significant (p ≤ .05) for child sex, weight, diagnosis, residence, surgery, parent or guardian age and education. Only age and surgery were significant for children ≥7 years. CONCLUSIONS Acute pain prevalence and intensity among hospitalized children in Botswana is low.
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Affiliation(s)
- Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana.
| | - Sharon Y Irving
- Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing, University of Pennsylvania, Nurse Practitioner, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andrew P Steenhoff
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana
| | - Rosemary C Polomano
- University of Pennsylvania, Philadelphia, Pennsylvania; School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania
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Mauritz MD, Uhlenberg F, Vettorazzi E, Ebenebe CU, Singer D, Deindl P. Impact of Propofol Bolus Administration on the Nociceptive Flexion Reflex Threshold and Bispectral Index in Children—A Case Series. CHILDREN 2021; 8:children8080639. [PMID: 34438531 PMCID: PMC8393661 DOI: 10.3390/children8080639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
We analyzed the impact of propofol administration during continuous sedation and analgesia on the nociceptive flexion reflex threshold (NFRT) and Bispectral Index (BIS) in ventilated children. We examined patients who received propofol before planned endotracheal suctioning. Patients were clinically assessed using the modified Face, Legs, Activity, Cry, Consolability (mFLACC) scale and COMFORT-B (Comfort Behavior) scale. We continuously recorded the NFRT and BIS. We recorded 23 propofol administrations in eight patients with an average age of 8.6 ± 3.5 years. The median (minimum-maximum) scores for the mFLACC scale and COMFORT-B scale were 0 (0–5) and 6 (6–17), respectively, before the bolus. The administration of a weight-adjusted propofol bolus of 1.03 ± 0.31 mg/kg resulted in an increase in NFRT and burst-suppression ratio; BIS and electromyogram values decreased. Changes from baseline (95% CI) after propofol bolus administration were BIS −23.9 (−30.8 to −17.1), EMG -10.5 dB (−13.3 to −7.7), SR 14.8 % (5.6 to 24.0) and NFRT 13.6 mA (5.5 to 21.7). Further studies are needed to determine whether sedated children may benefit from objective pain and sedation monitoring with BIS and NFRT.
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Affiliation(s)
- Maximilian David Mauritz
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.U.); (C.U.E.); (D.S.); (P.D.)
- Department of General Pediatrics and Adolescent Medicine, Children’s and Adolescents’ Hospital Datteln, Witten/Herdecke University, 45711 Datteln, Germany
- Correspondence: ; Tel.: +49-2363-9750
| | - Felix Uhlenberg
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.U.); (C.U.E.); (D.S.); (P.D.)
- Department of Pediatrics and Adolescent Medicine, Neonatology and Pediatric Intensive Care Medicine, Itzehoe Medical Center, 25524 Itzehoe, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Chinedu Ulrich Ebenebe
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.U.); (C.U.E.); (D.S.); (P.D.)
| | - Dominique Singer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.U.); (C.U.E.); (D.S.); (P.D.)
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.U.); (C.U.E.); (D.S.); (P.D.)
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12
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Sedation With Midazolam After Cardiac Surgery in Children With and Without Down Syndrome: A Pharmacokinetic-Pharmacodynamic Study. Pediatr Crit Care Med 2021; 22:e259-e269. [PMID: 33031353 DOI: 10.1097/pcc.0000000000002580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the pharmacokinetics and pharmacodynamics of IV midazolam after cardiac surgery between children with and without Down syndrome. DESIGN Prospective, single-center observational trial. SETTING PICU in a university-affiliated pediatric teaching hospital. PATIENTS Twenty-one children with Down syndrome and 17 without, 3-36 months, scheduled for cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Postoperatively, nurses regularly assessed the children's pain and discomfort with the validated COMFORT-Behavioral scale and Numeric Rating Scale for pain. A loading dose of morphine (100 µg/kg) was administered after coming off bypass; thereafter, morphine infusion was commenced at 40 µg/kg/hr. Midazolam was started if COMFORT-Behavioral scale score of greater than 16 and Numeric Rating Scale score of less than 4 (suggestive of undersedation). Plasma midazolam and metabolite concentrations were measured for population pharmacokinetic- and pharmacodynamic analysis using nonlinear mixed effects modeling (NONMEM) (Version VI; GloboMax LLC, Hanover, MD) software. MEASUREMENTS AND MAIN RESULTS Twenty-six children (72%) required midazolam postoperatively (15 with Down syndrome and 11 without; p = 1.00). Neither the cumulative midazolam dose (p = 0.61) nor the time elapsed before additional sedation was initiated (p = 0.71), statistically significantly differed between children with and without Down syndrome. Population pharmacokinetic and pharmacodynamics analysis revealed no statistically significant differences between the children with and without Down syndrome. Bodyweight was a significant covariate for the clearance of 1-OH-midazolam to 1-OH-glucuronide (p = 0.003). Pharmacodynamic analysis revealed a marginal effect of the midazolam concentration on the COMFORT-Behavioral score. CONCLUSIONS The majority of children with and without Down syndrome required additional sedation after cardiac surgery. This pharmacokinetic and pharmacodynamic analysis does not provide evidence for different dosing of midazolam in children with Down syndrome after cardiac surgery.
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Inal S, Demir D. Impact of Peripheral Venous Catheter Placement With Vein Visualization Device Support on Success Rate and Pain Levels in Pediatric Patients Aged 0 to 3 Years. Pediatr Emerg Care 2021; 37:138-144. [PMID: 29768292 DOI: 10.1097/pec.0000000000001493] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pediatric nurses should be able to use techniques that increase the success rate or shorten the procedural duration of peripheral intravenous catheterization (PIVC). OBJECTIVES This study was performed to define the effect of the infrared vein visualization device support on the success of PIVC in pediatric patients aged 0 to 3 years. Success was determined based on the number of attempts per patient, the duration of the procedure, the success rate of first attempts, and the pain levels of the children. METHODS The study was a randomized, controlled experimental study on 54 children aged 0 to 3 years. RESULTS Peripheral intravenous catheterization in the study group was performed with fewer attempts (study group: 1.44 ± 0.85 [median, 1]; control group: 2.41 ± 1.99 [median, 2]; P = 0.016) and in a shorter period (study group: 44.37 ± 32.22 [median, 40 seconds]; control group: 168.89 ± 171.54 [median, 112 seconds; P = 0.001), and the first attempt success rate in the study group (74.1%) was higher than in the control group (40.7%; P = 0.028). Also, the pain level of the children in the study group was significantly lower than that in the control group (P < 0.05). CONCLUSIONS In conclusion, PIVC supported by the infrared vein visualization device reduces the number of attempts per patient, reduces the duration of the procedure, and increases the success rate of first attempts, and there is procedural pain; therefore, vein visualization improves the success of PIVC.
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Affiliation(s)
- Sevil Inal
- From the Faculty of Health Sciences, Istanbul University
| | - Duygu Demir
- School of Nursing, Halic University, Istanbul, Turkey
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Devsam BU, Kinney S. The clinical utility of the pain assessment tool in ventilated, sedated, and muscle-relaxed neonates. Aust Crit Care 2020; 34:333-339. [PMID: 33223388 DOI: 10.1016/j.aucc.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The neonatal Pain Assessment Tool (PAT) is considered a reliable and valid tool for assessing neonatal pain. No research has been conducted on the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates. OBJECTIVE The objective of the study was to determine the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates. METHODS Neonatal nurses from the Royal Children's Hospital completed online surveys to assess the clinical utility of the PAT. Three focus groups were then conducted to further explore the variation of pain scores from the survey and clarify the challenges in interpreting the pain score. RESULTS Nurses perceived the PAT clinically useful in neonates who were ventilated and minimally sedated. However, the PAT was not clinically useful in neonates who were ventilated and heavily sedated or muscle-relaxed. Further exploration via focus groups highlighted two themes related to the 'variation in the timing of the pain score' and the 'integration of critical thinking and judgement' used when assessing pain in neonates. CONCLUSIONS The clinical utility of the PAT is acceptable for minimally sedated neonates; however, it decreases the more sedated a neonate becomes, and the PAT's usefulness is extremely poor in the muscle-relaxed neonate. A better understanding of the timing and interpretation of the pain score in relation to the neonate's clinical status may enable improved decision-making and pain management. The PAT requires further validity, reliability, and clinical utility research, particularly in critically ill and muscle-relaxed neonates.
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Affiliation(s)
- Bianca U Devsam
- Neonatal Intensive Care Unit (Butterfly Ward), The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Nursing Research Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, 3010, Australia.
| | - Sharon Kinney
- Nursing Research Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, 3010, Australia
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15
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Feasibility and Clinical Utility of the Finnish Version of the FLACC Pain Scale in PICU. J Pediatr Nurs 2020; 55:211-216. [PMID: 32961384 DOI: 10.1016/j.pedn.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the feasibility and clinical utility of the Finnish FLACC scale when assessing children's pain in a Pediatric Intensive Care Unit (PICU). DESIGN AND METHODS A non-experimental, descriptive cross-sectional study design was used to describe the feasibility and clinical utility in a Finnish PICU between May and August 2018. The nurses were asked to complete a data collection questionnaire about the feasibility and clinical utility of the Finnish FLACC every time they used the scale to assess pain in children. In total, the data consisted of 157 pain assessments cases. Quantitative data were analyzed statistically and responses to open-ended questions were analyzed using content analysis. RESULTS In most cases, the nurses agreed that the Finnish FLACC scale was clearly structured (97%), easy to use (98%), helpful in assessing pain intensity (77%), and useful when reassessing pain after interventions (67%). Nurses found the scale more useable for children over one year old than for younger children. When assessing cry and consolability, pain was easier to score if the child was not intubated. CONCLUSIONS The Finnish FLACC scale exhibits adequate feasibility and clinical utility when assessing pain in children in a PICU. However, more information is needed about its use during painful short-term procedures and with children under one year old. PRACTICE IMPLICATIONS The Finnish FLACC scale is a helpful tool for nurses when assessing children's pain in a PICU. However, the Finnish version of the modified FLACC is needed for use with intubated children in the future.
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Suprawoto DN, Nurhaeni N, Waluyanti FT. COMFORT Behavior Scale instrument: validity and reliability test for critically ill pediatric patients in Indonesia. Pediatr Rep 2020; 12:8690. [PMID: 32905068 PMCID: PMC7463139 DOI: 10.4081/pr.2020.8690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
The COMFORT Behavior Scale (CBS) is an instrument that has been validated in several languages to assess the levels of sedation in children. This project was implemented to identify the validity and reliability of CBS. The design used was an analytic descriptive cross-sectional approach. Fifty-one children aged 1 month to 18 years who received analgesic and/or sedation therapy were purposively selected and assessed for their sedation levels using CBS and the Nurse Interpretation of Sedation Score (NISS). The data were analyzed using the Mann-Whitney U test to measure the concurrent validity; each item was analyzed using Pearson correlation; inter-rater reliability was measured by the Kappa coefficient; and the internal consistency was measured by Cronbach's alpha. The results showed there was no significant correlation between the levels of sedation assessed using CBS and NISS (P= 0.118; α= 0.05). Six items in the CBS instrument were found to be valid (r= 0.348-0.813). The Cronbach's alpha for CBS was 0.873. Thus, the Indonesian version of CBS is valid and reliable in assessing sedation levels in children.
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Effect of Personalized Music Intervention in Mechanically Ventilated Children in the PICU: A Pilot Study. Pediatr Crit Care Med 2020; 21:e8-e14. [PMID: 31652195 DOI: 10.1097/pcc.0000000000002159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the feasibility of a personalized music intervention with mechanically ventilated patients in the PICU. DESIGN Pilot study with a quasi-experimental design. SETTING Tertiary children's hospital in China with a 40-bed PICU. PATIENTS Children, 1 month to 7 years, with mechanical ventilation were recruited and assigned to music group (n = 25) and control group (n = 25). INTERVENTIONS Children in the music group received their own favorite music and listened for 60 minutes three times a day. The control group receive routine care without music. MEASUREMENTS AND MAIN RESULTS Primary outcome measure was comfort measured with the COMFORT Behavior scale 5 minutes before and after the music. Secondary outcome measures were physiologic variables; heart rate, respiration, blood pressure, oxygen saturation. Mechanical ventilation time, length of stay, and sedation medication were also collected. Qualitative analysis revealed that nurses had a positive attitude in delivering the interventions and identified improvements for the main trial. Children in the music group had lower COMFORT Behavior scores (15.7 vs 17.6; p = 0.011). Children in the music group had better physiologic outcomes; heart rate (140 vs 144; p = 0.039), respiration rate (40 vs 43; p = 0.036), systolic blood pressure (93 vs 95 mm Hg; p = 0.031), oxygen saturation (96% vs 95%; p < 0.001), diastolic blood pressure was not significantly (52 vs 53 mm Hg; p = 0.11). Children in the music group had a shorter ventilation time (148.7 vs 187.6; p = 0.044) and a shorter length of stay, but not significant (11.2 vs 13.8; p = 0.071). Children in the control group had higher total amount of on-demand midazolam (29 vs 33 mg; p = 0.040). CONCLUSIONS Our pilot study indicates that personalized music intervention is feasible and might improve the comfort of children with mechanical ventilation. Further studies are needed to provide conclusive evidence in confirming the effectiveness of music interventions comforting critically ill children in PICUs.
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Tamvaki E, Efstratiou F, Nteli C, Matziou V, Pavlopoulou I, Myrianthefs P, Papathanassoglou E, Giannakopoulou M. Validation of the Greek Version of Comfort-B, FLACC, and BPS Scales in Critically Ill Children and Their Association with Clinical Severity. Pain Manag Nurs 2019; 21:468-475. [PMID: 31862298 DOI: 10.1016/j.pmn.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 09/21/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND A variety of valid pediatric pain assessment tools are used in clinical practice globally; however, none have been validated for use in the Pediatric Intensive Care Unit (PICU) in Greece. Furthermore, the association between pain behavioral responses and clinical status is unclear. AIMS To assess the reliability and validity of the Greek version of FLACC, Comfort B, and BPS pain scales in critically ill children and to explore their association with clinical severity (Denver MOF, PMODS) and levels of sedation and analgesia. METHODS A methodological and descriptive correlational study was performed in a 6-bed PICU. A total of 60 observations in a sample of 30 children (mean age 4.1 years; 63.3% male) were obtained by 2 independent nurses during rest and painful procedures. At the same time, the bedside nurse assessed the child's pain intensity using the VASobs. RESULTS High internal consistency and strong interrater reliability were detected (Cronbach's alpha ≥ .85; ICC > .95, p < .001). The agreement between observers was satisfactory (0.71 ≤ Kappa ≤ 0.96, p < .001). Strong correlations were found among the scales (0.65 ≤ rho ≤0 .98, p < .05). Increased pain scores (≥moderate pain) were observed during painful procedures regardless the administration of analgesia. Statistically significant correlations were found between clinical severity and the FLACC and Comfort B scores (-0.577 ≤ rho ≤ -0.384, p < .05). CONCLUSIONS These pain tools were found to be suitable for this sample of children in Greece. Wider application of these tools in Greek PICUs and further research regarding their association with the clinical severity and the pain responses is required for the improvement of pain management in critically ill children.
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Affiliation(s)
- Eleni Tamvaki
- Great Ormond Street Hospital, Cardiac Intensive Care Unit, London, UK
| | - Fragkoula Efstratiou
- Intensive Care Unit, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Charalampia Nteli
- Intensive Care Unit, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Vassiliki Matziou
- Department of Nursing, School of Health Sciences, National & Kapodistrian University of Athens, Greece
| | - Ioanna Pavlopoulou
- Department of Nursing, School of Health Sciences, National & Kapodistrian University of Athens, Greece
| | - Pavlos Myrianthefs
- Department of Nursing, School of Health Sciences, National & Kapodistrian University of Athens, Greece
| | | | - Margarita Giannakopoulou
- Department of Nursing, School of Health Sciences, National & Kapodistrian University of Athens, Greece.
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Ismail A, Forgeron P, Polomeno V, Gharaibeh H, Dagg W, Harrison D. Pain management interventions in the Paediatric Intensive Care Unit: A scoping review. Intensive Crit Care Nurs 2019; 54:96-105. [DOI: 10.1016/j.iccn.2019.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 01/18/2023]
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Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ravà L, Dall'Oglio I. Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People 2019; 30:27-33. [PMID: 30457241 DOI: 10.7748/ncyp.2018.e1081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Assessment of pain in paediatric intensive care units (PICUs) is crucial to minimise the risks of inadequate sedation. AIM To translate and validate the Italian version of the COMFORT behaviour scale (CBS) in a PICU in terms of its psychometric, construct, feasibility and reproducibility properties. METHOD Before and after tracheal suctioning, 71 observations were performed on 35 sedated and mechanically ventilated patients in three PICUs. Pain and distress were assessed using the CBS and the Nurse Interpretation of Sedation Score (NISS). RESULTS Interrater agreement and interrater reliability were high before the procedure and moderate after (pre: 100%, Cohen's kappa = 1; post: 79%, Cohen's kappa = 0.558). The scale's internal consistency was calculated before and after the procedure (Cronbach's alpha = 0.81 and 0.91). Agreement between the CBS and the NISS was low before and after the procedure (20% and 28%). The agreement between the tools was low because the NISS, a tool based on expert opinion, is not as precise as the CBS and could be affected by cultural biases. CONCLUSION The Italian version of the CBS proved to be valid and reproducible for the objective measurement of pain and distress in a wide age range of patients admitted to PICUs.
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Affiliation(s)
- Daniele Fagioli
- Clinical pharmacy unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Costanza Evangelista
- Respiratory unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional development, continuing education and nursing research service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Continuing education and nursing research service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Broccati
- Emergency department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucilla Ravà
- Clinical epidemiology unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional development, continuing education and nursing research service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Matula ST, Polomano RC, Irving SY. The state of the science in paediatric pain management practices in low-middle income countries: An integrative review. Int J Nurs Pract 2018; 24:e12695. [PMID: 30251308 DOI: 10.1111/ijn.12695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/30/2018] [Indexed: 12/31/2022]
Abstract
AIM Examine the state of the science for pain management in children living in low-middle income countries (LMIC). BACKGROUND Significant challenges exist in pain management for children living in LMIC. METHODS An integrative review was conducted using PRISMA guidelines for quality of reporting. Literature searches were completed using Medline, PubMed, Scopus, and CINAHL databases for publications between January 2006 and August 2016 using MeSH and primary search terms pain and LMIC. Full text publications were evaluated using GRADE criterion and methodology specific evaluation tools. RESULTS Of 1510 publications identified, 31 met the criteria for inclusion. Data were categorized into three broad themes: (1) magnitude of the pain problem with subthemes describing the burden of and resources for paediatric pain management; (2) perceptions, experience, and practices for managing pain in children residing in LMIC with subthemes addressing health care providers, parent/caregiver and children, respectively; and (3) pain management practices with pain assessment and treatment strategies as subthemes. CONCLUSION Current data on paediatric pain management in LMIC are limited with respect to describing the burden of pain, children's pain perceptions and experiences, and pain management practices. Rigorous investigations are needed to expand knowledge and address the pervasive problem of pain for children in LMIC.
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Affiliation(s)
- Samuel T Matula
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Rosemary C Polomano
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharon Y Irving
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bosch-Alcaraz A, Falcó-Pegueroles A, Jordan I. A literature review of comfort in the paediatric critical care patient. J Clin Nurs 2018. [PMID: 29516623 DOI: 10.1111/jocn.14345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To investigate the meaning of comfort and to contextualise it within the framework of paediatric critical care. BACKGROUND The concept of comfort is closely linked to care in all health contexts. However, in specific settings such as the paediatric critical care unit, it takes on particular importance. DESIGN A literature review was conducted. METHODS A literature search was performed of articles in English and Spanish in international health science databases, from 1992-March 2017, applying the quality standards established by the PRISMA methodology and the Joanna Briggs Institute. RESULTS A total of 1,203 publications were identified in the databases. Finally, 59 articles which met the inclusion criteria were entered in this literature review. Almost all were descriptive studies written in English and published in Europe. The concept of comfort was defined as the immediate condition of being strengthened through having the three types of needs (relief, ease and transcendence) addressed in the four contexts of experience (physical, psychospiritual, social and environmental). Only two valid and reliable tools for assessing comfort were found: the Comfort Scale and the Comfort Behavior Scale. CONCLUSIONS Comfort is subjective and difficult to assess. It has four facets: physical, emotional, social and environmental. High levels of noise and light are the inputs that cause the most discomfort. Comfort is a holistic, universal concept and an important component of quality nursing care.
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Affiliation(s)
- Alejandro Bosch-Alcaraz
- Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.,Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Hospital Sant Joan de Déu, Barcelona, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
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van der Heijden MJ, de Jong A, Rode H, Martinez R, van Dijk M. Assessing and addressing the problem of pain and distress during wound care procedures in paediatric patients with burns. Burns 2018; 44:175-182. [DOI: 10.1016/j.burns.2017.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
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Can live music therapy reduce distress and pain in children with burns after wound care procedures? A randomized controlled trial. Burns 2018; 44:823-833. [PMID: 29395407 DOI: 10.1016/j.burns.2017.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Burn wound care procedures are very painful and lead to distress. Live music therapy has shown beneficial effects on distress and pain in specific pediatric patient populations. In this study we measured whether live music therapy has beneficial effects in terms of less distress and pain in children with burns after wound care procedures. METHODS This randomized assessor-blinded controlled trial (RCT) took place at the burns unit of the Red Cross War Memorial Children's Hospital, Cape Town, South Africa. It included newly admitted inpatients between the ages of 0 and 13 years undergoing their first or second wound care procedures. Excluded were children with a hearing impairment or low level of consciousness. The intervention group received one live music therapy session directly after wound care in addition to standard care. The control group received standard care only. The primary outcome was distress measured with the Observational Scale of Behavioral Distress-revised (OSBD-r). The secondary outcome was pain measured with the COMFORT-behavioral scale (COMFORT-B). In addition, in children older than 5 years self-reported distress with the validated Wong-Baker scale (FACES) and pain with the Faces Pain Scale-Revised (FPS-R) were measured. Patients in both groups were videotaped for three minutes before wound care; during the music therapy or the control condition; and for two minutes thereafter. Two researchers, blinded to the study condition, independently scored the OSBD-r and the COMFORT-B from the video footage before and after music therapy. RESULTS We included 135 patients, median age 22.6 months (IQR 15.4-40.7 months). Change scores did not significantly differ between the intervention and the control groups for either distress (p=0.53; d=0.11; 95% CI -0.23 to 0.45) or pain (p=0.99; d=0.04; 95% CI -0.30 to 0.38). Self-reported distress in a small group of children (n=18) older than 5 years indicated a significant reduction in distress after live music therapy (p=0.05). CONCLUSIONS Live music therapy was not found effective in reducing distress and pain in young children after burn wound care. Older children might be more responsive to this intervention.
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Lorente S, Losilla JM, Vives J. Instruments to assess patient comfort during hospitalization: A psychometric review. J Adv Nurs 2017; 74:1001-1015. [PMID: 29098701 DOI: 10.1111/jan.13495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
AIM To analyse the psychometric properties and the utility of instruments used to measure patient comfort, physical, social, psychospiritual and/or environmental, during hospitalization. BACKGROUND There are no systematic reviews nor psychometric reviews of instruments used to measure comfort, which is considered an indicator of quality in health care associated with quicker discharges, increased patient satisfaction and better cost-benefit ratios for the institution. DESIGN Psychometric review. DATA SOURCES MEDLINE, CINAHL, PsycINFO, Web of Knowledge, ProQuest Thesis&Dissertations, Google. REVIEW METHODS We limited our search to studies published between 1990-2015. The psychometric analysis was performed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN), along with the Quality Criteria for Measurement Properties. The utility of the instruments was assessed according to their cost-efficiency, acceptability and educational impact. Protocol registration in PROSPERO, CRD42016036290. RESULTS Instruments reviewed showed moderate methodological quality and their utility was poorly reported. Thus, we cannot recommend any questionnaire without reservations, but the Comfort Scale, the General Comfort Questionnaire and their adaptations in adults and older patients, the Psychosocial Comfort Scale and the Incomfort des Patients de Reanimation are the most recommendable instruments to measure comfort. CONCLUSIONS The methodology of the studies should be more rigorous and authors should adequately report the utility of instruments. This review provides a strategy to select the most suitable instrument to assess patient comfort according to their psychometric properties and utility, which is crucial for nurses, clinicians, researchers and institutions.
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Affiliation(s)
- Sonia Lorente
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital de Terrassa, Barcelona, Spain
| | - Josep-Maria Losilla
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Vives
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Barcelona, Spain
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Ramírez-Carrasco A, Butrón-Téllez Girón C, Sanchez-Armass O, Pierdant-Pérez M. Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration. Pain Res Manag 2017; 2017:1434015. [PMID: 28490941 PMCID: PMC5405389 DOI: 10.1155/2017/1434015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022]
Abstract
Background and Objective. Anxiety/pain are experiences that make dental treatment difficult for children, especially during the time of anesthesia. Hypnosis is used in pediatric clinical situations to modify thinking, behavior, and perception as well as, recently, in dentistry; therefore the aim of this study was to evaluate the effectiveness of hypnosis combined with conventional behavior management techniques during infiltration anesthetic. Methods. Anxiety/pain were assessed with the FLACC scale during the anesthetic moment, as well as heart rate variability and skin conductance before and during the anesthetic moment, between the control and experimental group. Results. A marginal statistical difference (p = 0.05) was found in the heart rate between baseline and anesthetic moment, being lower in the hypnosis group. No statistically significant differences were found with the FLACC scale or in the skin conductance (p > 0.05). Conclusion. Hypnosis combined with conventional behavior management techniques decreases heart rate during anesthetic infiltration showing that there may be an improvement in anxiety/pain control through hypnotic therapy.
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Affiliation(s)
- A. Ramírez-Carrasco
- Posgrado de Estomatología Pediátrica, Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, Avenida Manuel Nava 2, 78290 San Luis Potosí, SLP, Mexico
| | - C. Butrón-Téllez Girón
- Laboratorio de Bioquímica, Microbiología y Patología, Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, Avenida Manuel Nava 2, 78290 San Luis Potosí, SLP, Mexico
| | - O. Sanchez-Armass
- Facultad de Psicología, Universidad Autónoma de San Luis Potosí, De Los Talleres 186, Valle Dorado, 78399 San Luis Potosí, SLP, Mexico
| | - M. Pierdant-Pérez
- Departamento de Epidemiología Clínica, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Avenida Venustiano Carranza 2405, 78210 San Luis Potosí, SLP, Mexico
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de Melo GM, Lélis ALPDA, de Moura AF, Cardoso MVLML, da Silva VM. [Pain assessment scales in newborns: integrative review]. REVISTA PAULISTA DE PEDIATRIA 2016; 32:395-402. [PMID: 25511005 PMCID: PMC4311795 DOI: 10.1016/j.rpped.2014.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 04/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze studies on methods used to assess pain in newborns. DATA SOURCES Integrative review study of articles published from 2001 to 2012, carried out in the following databases: Scopus, PubMed, CINAHL, LILACS and Cochrane. The sample consisted of 13 articles with level of evidence 5. DATA SYNTHESIS 29 pain assessment scales in newborns, including 13 one-dimensional and 16 multidimensional, that assess acute and prolonged pain in preterm and full-term infants were available in scientific publications. CONCLUSION Based on the characteristics of scales, one cannot choose a single one as the most appropriate scale, as this choice will depend on gestational age, type of painful stimulus and the environment in which the infant is inserted. It is suggested the use of multidimensional or one-dimensional scales; however, they must be reliable and validated.
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28
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The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit. Pain Manag Nurs 2016; 17:372-383. [DOI: 10.1016/j.pmn.2016.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
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Lima AGCF, Santos VS, Nunes MS, Barreto JAA, Ribeiro CJN, Carvalho J, Ribeiro MCO. Glucose solution is more effective in relieving pain in neonates than non-nutritive sucking: A randomized clinical trial. Eur J Pain 2016; 21:159-165. [PMID: 27460979 DOI: 10.1002/ejp.912] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies have compared the analgesic effect of 25% glucose and non-nutritive sucking. We compared the analgesic effect of 25% glucose and non-nutritive sucking in newborns undergoing hepatitis B vaccination. Our hypothesis is that 25% glucose is more effective in relieving pain than non-nutritive sucking. METHODS A randomized clinical trial with 78 healthy newborns was performed. Neonates were assigned randomly to receive 25% glucose (G25) and non-nutritive sucking (NNS). Pain was assessed using the Neonatal Infant Pain Scale (NIPS) before and during the immunization procedure. In addition, we evaluated various physiological parameters and crying time. RESULTS Neonates who received 25% glucose registered lower NIPS scores than those from the NNS group [mean (SD), 3.3 (2.1) vs. 5.6 (1.6), p < 0.001]. The crying time was shorter among newborns in the G25 group than in the NNS and control groups. CONCLUSION The use of 25% glucose before the vaccination procedure was more effective in relieving acute pain, with newborns in the G25 group registering scores two times lower on the NIPS scale. The clinical practice of administering 25% glucose is therefore a suggested nondrug measure for pain relief during painful procedures. SIGNIFICANCE Neonates who received 25% glucose registered lower NIPS scores than those from the NNS group; the crying time was shorter among newborns in the G25 group than in the NNS and control groups; the use of 25% glucose before the vaccination procedure was more effective in relieving acute pain.
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Affiliation(s)
- A G C F Lima
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | - V S Santos
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | - M S Nunes
- Department of Nursing, Federal University of Sergipe, Lagarto, Brazil
| | - J A A Barreto
- Department of Nursing, Federal University of Sergipe, Lagarto, Brazil
| | - C J N Ribeiro
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | - J Carvalho
- Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
| | - M C O Ribeiro
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
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Maaskant J, Raymakers-Janssen P, Veldhoen E, Ista E, Lucas C, Vermeulen H. The clinimetric properties of the COMFORT scale: A systematic review. Eur J Pain 2016; 20:1587-1611. [PMID: 27161119 DOI: 10.1002/ejp.880] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 11/08/2022]
Abstract
The COMFORT scale is a measurement tool to assess distress, sedation and pain in nonverbal paediatric patients. Several studies have described the COMFORT scale, but no formal assessment of the methodological quality has been undertaken. Therefore, we performed a systematic review to study the clinimetric properties of the (modified) COMFORT scale in children up to 18 years. We searched Central, CINAHL, Embase, Medline, PsycInfo and Web of Science until December 2014. The selection, data extraction and quality assessment were performed independently by two reviewers. Quality of the included studies was appraised using the COSMIN checklist. We found 30 studies that met the inclusion criteria. Most participants were ventilated children up to 4 years without neurological disorders. The results on internal consistency and interrater reliability showed values of >0.70 in most studies, indicating an adequate reliability. Construct validity resulted in correlations between 0.68 and 0.84 for distress, between 0.42 and 0.94 for sedation and between 0.31 and 0.96 for pain. The responsiveness of the (modified) COMFORT scale seems to be adequate. The quality of the included studies ranged from poor to excellent. The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain. The included studies were clinically and methodologically heterogeneous, hampering firm conclusions. WHAT DOES THIS REVIEW ADD?: An in-depth assessment of the clinimetric properties of the COMFORT scale. The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain.
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Affiliation(s)
- J Maaskant
- Emma Children's Hospital, Academic Medical Center Amsterdam, The Netherlands. .,Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - P Raymakers-Janssen
- Pediatric Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - E Veldhoen
- Pediatric Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - E Ista
- Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Lucas
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - H Vermeulen
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Health Professions, Amsterdam, The Netherlands
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Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med 2016; 42:972-86. [PMID: 27084344 PMCID: PMC4846705 DOI: 10.1007/s00134-016-4344-1] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 03/23/2016] [Indexed: 01/12/2023]
Abstract
Background This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child to a series of painful and stressful events. Accurate assessment of the presence of pain and non-pain-related distress (adequacy of sedation, iatrogenic withdrawal syndrome and delirium) is essential to good clinical management and to monitoring the effectiveness of interventions to relieve or prevent pain and distress in the individual patient. Methods A multidisciplinary group of experts was recruited from the members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). The group formulated clinical questions regarding assessment of pain and non-pain-related distress in critically ill and nonverbal children, and searched the PubMed/Medline, CINAHL and Embase databases for studies describing the psychometric properties of assessment instruments. Furthermore, level of evidence of selected studies was assigned and recommendations were formulated, and grade or recommendations were added on the basis of the level of evidence. Results An ESPNIC position statement was drafted which provides clinical recommendations on assessment of pain (n = 5), distress and/or level of sedation (n = 4), iatrogenic withdrawal syndrome (n = 3) and delirium (n = 3). These recommendations were based on the available evidence and consensus amongst the experts and other members of ESPNIC. Conclusions This multidisciplinary ESPNIC position statement guides professionals in the assessment and reassessment of the effectiveness of treatment interventions for pain, distress, inadequate sedation, withdrawal syndrome and delirium. Electronic supplementary material The online version of this article (doi:10.1007/s00134-016-4344-1) contains supplementary material, which is available to authorized users.
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32
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Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children. Pain 2015. [DOI: 10.1097/j.pain.0000000000000305] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bai J, Jiang N. Where Are We: A Systematic Evaluation of the Psychometric Properties of Pain Assessment Scales for Use in Chinese Children. Pain Manag Nurs 2015; 16:617-31. [DOI: 10.1016/j.pmn.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/26/2014] [Indexed: 02/02/2023]
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34
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Ge X, Tao JR, Wang J, Pan SM, Wang YW. Bayesian estimation on diagnostic performance of Face, Legs, Activity, Cry, and Consolability and Neonatal Infant Pain Scale for infant pain assessment in the absence of a gold standard. Paediatr Anaesth 2015; 25:834-839. [PMID: 25929312 DOI: 10.1111/pan.12664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonverbal pediatric patients such as infants are unable to describe their pain, which leads to the lack of a gold standard scale for their pain assessment. The aim of this study was to estimate the diagnostic performance of Face, Legs, Activity, Cry, and Consolability (FLACC) scale and Neonatal Infant Pain Scale (NIPS) for infants' pain in the absence of a gold standard. METHODS This prospective observational study recruited 202 postoperative infants, aged <12 months. Postoperative pain intensity was evaluated using FLACC and NIPS scales. The diagnostic performance of these two scales was to estimate using a Bayesian latent class model with conditional dependence. McNemar's test was applied to test whether NIPS and FLACC tests differ from each other. RESULTS Under a combined model with conditional dependence, the median posterior sensitivity and specificity of the FLACC were 89.94% (95% CI: 78.48-96.83%) and 87.82% (95% CI: 78.6-95.23%), respectively. The sensitivity and specificity of the NIPS were 85.94% (95% CI: 72.15-95.6%) and 92.61% (84.05-97.52%), respectively. McNemar's test demonstrated no significant difference between FLACC and NIPS in either sensitivity or specificity. CONCLUSION Both the FLACC and NIPS have excellent sensitivity and specificity for pain assessment in infants. The comparison test showed that the FLACC scale was no different to the NIPS scale in sensitivity and specificity.
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Affiliation(s)
- Xiaoli Ge
- Emergency Department, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Anesthesiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Ru Tao
- Department of Anesthesiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Wang
- Department of Anesthesiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Ming Pan
- Emergency Department, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Wei Wang
- Department of Anesthesiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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35
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Sönmez Düzkaya D, Kuğuoğlu S. Assessment of Pain During Endotracheal Suction In the Pediatric Intensive Care Unit. Pain Manag Nurs 2015; 16:11-9. [DOI: 10.1016/j.pmn.2014.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 11/28/2022]
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36
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Pain assessment scales in newborns: integrative review* *Study conducted at Universidade Federal do Ceará, Fortaleza, CE, Brazil. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/s2359-3482(15)30076-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Melo GMD, Lélis ALPDA, Moura AFD, Cardoso MVLML, Silva VMD. Pain assessment scales in newborns: integrative review. REVISTA PAULISTA DE PEDIATRIA 2014. [DOI: 10.1590/s0103-05822014000400017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To analyze studies on methods used to assess pain in newborns.DATA SOURCES: Integrative review study of articles published from 2001 to 2012, carried out in the following databases: Scopus, PubMed, CINAHL, LILACS and Cochrane. The sample consisted of 13 articles with level of evidence 5.DATA SYNTHESIS: 29 pain assessment scales in newborns, including 13 one-dimensional and 16 multidimensional, that assess acute and prolonged pain in preterm and full-term infants were available in scientific publications.CONCLUSION: Based on the characteristics of scales, one cannot choose a single one as the most appropriate scale, as this choice will depend on gestational age, type of painful stimulus and the environment in which the infant is inserted. It is suggested the use of multidimensional or one-dimensional scales; however, they must be reliable and validated.
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38
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Calcaterra V, Ostuni S, Bonomelli I, Mencherini S, Brunero M, Zambaiti E, Mannarino S, Larizza D, Albertini R, Tinelli C, Pelizzo G. Music benefits on postoperative distress and pain in pediatric day care surgery. Pediatr Rep 2014; 6:5534. [PMID: 25635217 PMCID: PMC4292057 DOI: 10.4081/pr.2014.5534] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/01/2014] [Accepted: 08/06/2014] [Indexed: 11/23/2022] Open
Abstract
Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001). Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.
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Affiliation(s)
- Valeria Calcaterra
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia; ; Department of Internal Medicine, University of Pavia ; Pavia, Italy
| | - Selene Ostuni
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
| | - Irene Bonomelli
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia
| | | | - Marco Brunero
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
| | - Elisa Zambaiti
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
| | - Savina Mannarino
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia
| | - Daniela Larizza
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia; ; Department of Internal Medicine, University of Pavia ; Pavia, Italy
| | | | - Carmine Tinelli
- Biometry and Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation , Pavia, Italy
| | - Gloria Pelizzo
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
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Boerlage A, Ista E, Duivenvoorden H, de Wildt S, Tibboel D, van Dijk M. The COMFORT behaviour scale detects clinically meaningful effects of analgesic and sedative treatment. Eur J Pain 2014; 19:473-9. [DOI: 10.1002/ejp.569] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- A.A. Boerlage
- Intensive Care and Department of Pediatric Surgery; Erasmus MC - Sophia Children's Hospital; The Netherlands
| | - E. Ista
- Intensive Care and Department of Pediatric Surgery; Erasmus MC - Sophia Children's Hospital; The Netherlands
| | - H.J. Duivenvoorden
- Intensive Care and Department of Pediatric Surgery; Erasmus MC - Sophia Children's Hospital; The Netherlands
| | - S.N. de Wildt
- Intensive Care and Department of Pediatric Surgery; Erasmus MC - Sophia Children's Hospital; The Netherlands
| | - D. Tibboel
- Intensive Care and Department of Pediatric Surgery; Erasmus MC - Sophia Children's Hospital; The Netherlands
| | - M. van Dijk
- Intensive Care and Department of Pediatric Surgery; Erasmus MC - Sophia Children's Hospital; The Netherlands
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Brasher C, Gafsous B, Dugue S, Thiollier A, Kinderf J, Nivoche Y, Grace R, Dahmani S. Postoperative pain management in children and infants: an update. Paediatr Drugs 2014; 16:129-40. [PMID: 24407716 DOI: 10.1007/s40272-013-0062-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many factors contribute to suboptimal pain management in children. Current evidence suggests that severe pain in children has significant long-lasting effects, even more so than in adults. In particular, recent evidence suggests a lack of optimal postoperative pain management in children, especially following ambulatory surgery. This review provides simple guidelines for the management of postoperative pain in children. It discusses the long-term effects of severe pain and how to evaluate pain in both healthy and neurologically impaired children, including neonates. Currently available treatment options are discussed with reference to the efficacy and side effects of opioid and non-opioid and regional analgesic techniques. The impact of preoperative anxiety on postoperative pain, and the efficacy of some nonpharmacological techniques such as hypnosis or distraction, are also discussed. Finally, basic organizational strategies are described, aiming to promote safer and more efficient postoperative pain management in children.
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Affiliation(s)
- Christopher Brasher
- Department of Anesthesiology, Intensive Care, Robert Debré Hospital, 48 Bd Sérurier, 75019, Paris, France
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Bai J. Letter to the Editor. Pain 2014; 155:833-834. [DOI: 10.1016/j.pain.2013.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 08/03/2013] [Accepted: 08/09/2013] [Indexed: 12/01/2022]
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Bai J, Hsu L. Pain status and sedation level in Chinese children after cardiac surgery: an observational study. J Clin Nurs 2012; 22:137-47. [PMID: 22978412 DOI: 10.1111/j.1365-2702.2012.04263.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study explored current pain status, sedation level and their trajectories in Chinese children after cardiac surgery. Background. Pain and sedation management are fundamental care practices in the critical care setting, yet they both are frequently under-implemented for children after major surgery. DESIGN Repeated observational design. METHODS This study was conducted in a paediatric medical centre in Shanghai, China where 170 children who underwent cardiac surgery were recruited. Pain was measured with the face, legs, activity, cry, consolability scale and sedation levels with the COMFORT Behaviour Scale at 18 fixed time-points for three consecutive postoperative days. Results. The study indicated that 95 children (55·9%) received continuous opioids for pain relief, and 61 children (35·9%) received no analgesics. Multiple sedatives were used for these children, including bolus phenobarbital for 117 children (68·8%), phenergan for 81 children (47·6%) and midazolam for three children (1·8%). The mean pain scores significantly decreased throughout the operation day (POD-0) to the 2nd postoperative day (POD-2) with the lowest score on POD-2. Less than 5% of pain assessments were identified as moderate to severe across all 2815 observations. The sedation scores significantly increased through POD-0 to POD-2 with the highest score on POD-2. The rate of over-sedation was 50·3% with <1% under-sedation occurring among all the observations. Results also suggested that the length of stay in the cardiac intensive care unit was a predictor of increased analgesic usage in the critical care setting (odds ratio: 1·72). CONCLUSIONS Usage of analgesic and sedative agents in cardiac intensive care unit was variable and children experienced low pain scores but a high rate of over-sedation, indicating that healthcare providers should address ways to improve postoperative pain and sedation management in this population. RELEVANCE TO CLINICAL PRACTICE The pain and sedation status for children after cardiac surgery changed across the postoperative days. Healthcare providers should be trained in the use of reliable tools to accurately monitor children's pain and sedation levels.
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Affiliation(s)
- Jinbing Bai
- School of Nursing, Tianjin Medical University, Tianjin, China
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