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Reliability of two behavioral tools to assess pain in preterm neonates.

CONTEXT
One of the main difficulties in adequately treating the pain of neonatal patients is the scarcity of validated pain evaluation methods for this population.


OBJECTIVE
To analyze the reliability of two behavioral pain scales in neonates.


TYPE OF STUDY
Cross-sectional.


SETTING
University hospital neonatal intensive care unit.


PARTICIPANTS
22 preterm neonates were studied, with gestational age of 34 +/- 2 weeks, birth weight of 1804 +/- 584 g, 68% female, 30 +/- 12 hours of life, and 30% intubated.


PROCEDURES
Two neonatologists (A and B) observed the patients at the bedside and on video films for 10 minutes. The Neonatal Facial Coding System and the Clinical Scoring System were scored at 1, 5, and 10 minutes. The final score was the median of the three values for each observer and scale. A and B were blinded to each other. Video assessments were made three months after bedside evaluations.


MAIN MEASUREMENTS
End scores were compared between the observers using the intraclass correlation coefficient and bias analysis (paired t test and signal test).


RESULTS
For the Neonatal Facial Coding System, at the bedside and on video, A and B showed a significant correlation of scores (intraclass correlation score: 0.62), without bias between them (t test and signal test: p > 0.05). For the Clinical Scoring System bedside assessment, A and B showed correlation of scores (intraclass correlation score: 0.55), but bias was also detected between them: A scored on average two points higher than B (paired t test and signal test: p < 0.05). For the Clinical Scoring System video assessment, A and B did not show correlation of scores (intraclass correlation score: 0.25), and bias was also detected between them (paired t-test and signal test: p < 0.05).


CONCLUSION
The results strengthen the reliability of the Neonatal Facial Coding System for bedside pain assessment in preterm neonates.