Sulla Francesco, La Chimia Melania, Barbieri Lucrezia, Gigantiello Antonella, Iraci Concetta, Virgili Giulia, Artioli Giovanna, Sarli Leopoldo
Department of Medicine and Surgery, Parma University, Italy.
Acta Biomed. 2018 Dec 7;89(7-S):19-24. doi: 10.23750/abm.v89i7-S.7945.
Numerous negative outcomes of inadequate pain management among children have been cited in the literature. Inadequate pain management may be particularly detrimental to children and adolescents facing life-threatening injury or illness on a Paediatric Intensive Care Unit (PICU). It is therefore absolutely necessary that professionals utilize effective and efficient tools in order to evaluate a person's sensations of pain in the most objective way possible. The COMFORT-B scale is recognised as the gold standard in such patients. However, the use of this instrument in the clinical PICU setting is disputed. It requires long periods of observation to ensure an adequate utilization. Boerlage et al. noted that nurses are often impatient and do not always observe the patient for the recommended 2 minutes period. The Behavioral Pain Scale (BPS), instead, is considered to be the gold standard for pain assessment in deeply sedated, mechanically ventilated adult patients. This observational pain scale requires shorter observation time compared to the COMFORT-B. Moreover, BPS three subscales are included in other observational pain scales for paediatric patients. Therefore, the objective of this study was to assess the applicability of the BPS for use with paediatric patients.
Firstly, a questionnaire was administered to physicians and nursing staff that work in the units where the study was conducted in order to investigate the actual use of observational pain scales in their units. A second questionnaire was administered to a group of experts regarding the BPS, to assess both face validity and content validity, and to gain opinions on the relative appropriateness of each item. A descriptive, comparative design was used. A convenience sample of non-verbal, sedated and mechanically ventilated critical care paediatric patients was included. 39 observations were collected from 9 patients, all in their first year of age. Patient pain was assessed concurrently with the three observational scales, before, during and after routine procedures that are considered painful and non-painful.
The data collected through questionnaires for professionals gave a useful insight into pain assessment in the investigated units: only 46% of respondents stated that they assessed patients' pain levels, with an average of 2.8 times per shift; 60% of respondents declared to be unhappy with the observational scales that they utilise. Regarding the observations, internal consistency was α = .865. Correlations between BPS and the other instruments were high, demonstrating a good concurrent validity of the test. T test and ROC curves demonstrated a good discriminant validity as well.
Although the current study is based on a small sample of participants, these first results encourage us to continue working in the validation of the BPS in paediatric patients.
文献中列举了儿童疼痛管理不足的众多负面后果。疼痛管理不足对于在儿科重症监护病房（PICU）面临危及生命的损伤或疾病的儿童和青少年可能尤其有害。因此，专业人员绝对有必要使用有效且高效的工具，以便尽可能客观地评估一个人的疼痛感受。COMFORT - B量表被公认为此类患者的金标准。然而，在临床PICU环境中使用该工具存在争议。它需要长时间观察以确保充分利用。Boerlage等人指出，护士往往不耐烦，并不总是按照建议的2分钟时长观察患者。相反，行为疼痛量表（BPS）被认为是深度镇静、机械通气成年患者疼痛评估的金标准。与COMFORT - B相比，这个观察性疼痛量表所需的观察时间更短。此外，BPS的三个子量表包含在其他儿科患者观察性疼痛量表中。因此，本研究的目的是评估BPS在儿科患者中的适用性。
首先，向在开展研究的科室工作的医生和护理人员发放问卷，以调查他们科室观察性疼痛量表的实际使用情况。向一组专家发放关于BPS的第二份问卷，以评估其表面效度和内容效度，并征求他们对每个项目相对适宜性的意见。采用描述性、对比性设计。纳入非语言、镇静且机械通气的儿科重症监护患者的便利样本。从9名均为1岁的患者中收集了39次观察数据。在被认为有疼痛和无疼痛的常规操作之前、期间和之后，同时使用三种观察性量表评估患者疼痛。
通过向专业人员发放问卷收集的数据，让我们对被调查科室的疼痛评估有了有用的了解：只有46%的受访者表示他们会评估患者的疼痛程度，每班平均评估2.8次；60%的受访者表示对他们使用的观察性量表不满意。关于观察结果，内部一致性α = 0.865。BPS与其他工具之间的相关性很高，表明该测试具有良好的同时效度。T检验和ROC曲线也显示出良好的判别效度。
尽管当前研究基于小样本参与者，但这些初步结果鼓励我们继续致力于BPS在儿科患者中的验证工作。
