The influence of gestational age in the psychometric testing of the Bernese Pain Scale for Neonates

BMC Pediatrics

卷:19

Dirk Bassler¹  Sven Schulzke²  Eva Cignacco³  Reto Bürgin³  Karin Schenk³  Bonnie Stevens⁴  Mathias Nelle⁵  Liliane Stoffel⁵ 

[1] Department of Neonatology, University Hospital Zurich and University of Zurich;

[2] Department of Neonatology, University of Basel Children’s Hospital (UKBB);

[3] Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences;

[4] Lawrence S. Bloomberg Faculty of Nursing and Faculties of Medicine and Dentistry, University of Toronto;

[5] Neonatalogy, Children’s Hospital, University Hospital of Bern;

关键词: Pain assessment;    Neonates;    Premature infants;    Psychometric testing;    Contextual factors;    Gestational age;   

DOI  :  10.1186/s12887-018-1380-8

来源: DOAJ

【 摘 要 】

Abstract Background Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs. Methods In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1–5 capillary heel sticks in their first 14 days of life. From each heel stick, we produced three video sequences: baseline; heel stick; and, recovery. Five blinded nurses rated neonates’ pain responses according to the BPSN. The underlying factor structure of the BPSN, interrater reliability, concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, sensitivity and specificity, and the relationship between behavioural and physiological indicators were explored. We considered GA and gender as individual contextual factors. Results The factor analyses resulted in a model where the following behaviours best fit the data: crying; facial expression; and, posture. Pain scores for these behavioural items increased on average more than 1 point during the heel stick phases compared to the baseline and recovery phases (p < 0.001). Among physiological items, heart rate was more sensitive to pain than oxygen saturation. Heart rate averaged 0.646 points higher during the heel stick than the recovery phases (p < 0.001). GA increased along with pain scores: for every additional week of gestation, the average increase of behavioural pain score was 0.063 points (SE = 0.01, t = 5.49); average heart rate increased 0.042 points (SE = 0.01, t = 6.15). Sensitivity and specificity analyses indicated that the cut-off should increase with GA. Modified BPSN showed good concurrent validity with the PIPP-R (r = 0.600–0.758, p < 0.001). Correlations between the modified behavioural subscale and the item heart rate were low (r = 0.102–0.379). Conclusions The modified BPSN that includes facial expression, crying, posture, and heart rate is a reliable and valid tool for assessing acute pain in full-term and preterm neonates, but our results suggest that adding different cut-off points for different GA-groups will improve the BPSN’s clinical usefulness. Trial registration The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016.

【 授权许可】

Unknown