Great Ormond Street Hospital, Cardiac Intensive Care Unit, London, UK.
Intensive Care Unit, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece.
Pain Manag Nurs. 2020 Oct;21(5):468-475. doi: 10.1016/j.pmn.2019.10.004. Epub 2019 Dec 18.
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.
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.
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.
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).
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.
全球临床实践中使用了多种有效的儿科疼痛评估工具；然而，在希腊的儿科重症监护病房（PICU）尚未验证任何工具的适用性。此外，疼痛行为反应与临床状况之间的关系尚不清楚。
评估希腊版 FLACC、Comfort B 和 BPS 疼痛量表在危重症儿童中的可靠性和有效性，并探讨其与临床严重程度（丹佛多器官功能障碍评分、PMODS）和镇静、镇痛水平的关系。
在一个 6 床的 PICU 中进行了一项方法学和描述性相关性研究。通过 2 名独立护士在休息和疼痛操作期间对 30 名儿童（平均年龄 4.1 岁；63.3%为男性）的样本中的 60 次观察获得。同时，床边护士使用 VASobs 评估儿童的疼痛强度。
高内部一致性和强评分者间信度（Cronbach's alpha ≥.85；ICC>.95，p<.001）。观察者之间的一致性令人满意（0.71≤Kappa≤0.96，p<.001）。各量表之间存在强相关性（0.65≤rho≤0.98，p<.05）。无论是否给予镇痛，在疼痛操作期间均观察到疼痛评分增加（≥中度疼痛）。临床严重程度与 FLACC 和 Comfort B 评分之间存在统计学显著相关性（-0.577≤rho≤-0.384，p<.05）。
这些疼痛工具在希腊的儿童样本中是适用的。在希腊的 PICU 中更广泛地应用这些工具，并进一步研究其与临床严重程度和疼痛反应的关系，有助于改善危重症儿童的疼痛管理。
