van Dijk Monique, Roofthooft Daniella W E, Anand Kanwaljeet J S, Guldemond Fleur, de Graaf Joke, Simons Sinno, de Jager Youette, van Goudoever Johannes B, Tibboel Dick
Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Room Sk 1276, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
Clin J Pain. 2009 Sep;25(7):607-16. doi: 10.1097/AJP.0b013e3181a5b52a.
Pain assessment is essential to tailor intensive care of neonates. The present focus is on acute procedural pain; assessment of pain of longer duration remains a challenge. We therefore tested a modified version of the COMFORT-behavior scale-named COMFORTneo-for its psychometric qualities in the Neonatal Intensive Care Unit setting.
In a clinical observational study, nurses assessed patients with COMFORTneo and Numeric Rating Scales (NRS) for pain and distress, respectively. Interrater reliability, concurrent validity, and sensitivity to change were calculated as well as sensitivity and specificity for different cut-off scores for subsets of patients.
Interrater reliability was good: median linearly weighted Cohen kappa 0.79. Almost 3600 triple ratings were obtained for 286 neonates. Internal consistency was good (Cronbach alpha 0.84 and 0.88). Concurrent validity was demonstrated by adequate and good correlations, respectively, with NRS-pain and NRS-distress: r=0.52 (95% confidence interval 0.44-0.59) and r=0.70 (95% confidence interval 0.64-0.75). COMFORTneo cut-off scores of 14 or higher (score range is 6 to 30) had good sensitivity and specificity (0.81 and 0.90, respectively) using NRS-pain or NRS-distress scores of 4 or higher as criterion.
The COMFORTneo showed preliminary reliability. No major differences were found in cut-off values for low birth weight, small for gestational age, neurologic impairment risk levels, or sex. Multicenter studies should focus on establishing concurrent validity with other instruments in a patient group with a high probability of ongoing pain.
疼痛评估对于新生儿重症监护的个性化治疗至关重要。目前的重点是急性程序性疼痛；对持续时间较长的疼痛进行评估仍然是一项挑战。因此，我们在新生儿重症监护病房环境中测试了一种改良版的舒适行为量表——命名为COMFORTneo——的心理测量学特性。
在一项临床观察性研究中，护士分别使用COMFORTneo和数字评分量表（NRS）对患者的疼痛和痛苦程度进行评估。计算了评分者间信度、同时效度和对变化的敏感性，以及针对不同患者亚组的不同截断分数的敏感性和特异性。
评分者间信度良好：线性加权科恩kappa中位数为0.79。对286名新生儿进行了近3600次三重评分。内部一致性良好（克朗巴哈α系数分别为0.84和0.88）。与NRS疼痛评分和NRS痛苦评分分别具有充分且良好的相关性，证明了同时效度：r = 0.52（95%置信区间0.44 - 0.59）和r = 0.70（95%置信区间0.64 - 0.75）。以NRS疼痛评分或NRS痛苦评分4分及以上为标准，COMFORTneo截断分数为14或更高（分数范围为6至30）时，具有良好的敏感性和特异性（分别为0.81和0.90）。
COMFORTneo显示出初步的可靠性。在低出生体重、小于胎龄、神经损伤风险水平或性别方面，截断值未发现重大差异。多中心研究应侧重于在有持续疼痛高可能性的患者群体中与其他工具建立同时效度。
