Sada Fatos, Chivers Paola, Cecelia Sokol, Statovci Sejdi, Ukperaj Kujtim, Hughes Jeffery, Hoti Kreshnik
Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.
School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.
JMIR Pediatr Parent. 2024 Dec 3;7:e64669. doi: 10.2196/64669.
Pain assessment in the infant population is challenging owing to their inability to verbalize and hence self-report pain. Currently, there is a paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools.
This study aimed to explore parents' assessment and intervention of pain in their infants at home following same-day surgery, using standardized pain assessment tools.
This prospective study initially recruited 109 infant boys undergoing circumcision (same-day surgery). To assess pain at home over 3 days after surgery, parents using iOS devices were assigned to use the PainChek Infant tool, which is a point-of-care artificial intelligence-enabled tool, while parents using Android devices were assigned to use the Observer-Administered Visual Analog Scale (ObsVAS) tool. Chi-square analysis compared the intervention undertaken and pain presence. Generalized estimating equations were used to evaluate outcomes related to construct validity and clinical utility. Receiver operating characteristic analysis assessed pain score cutoffs in relation to the intervention used.
A total of 69 parents completed postsurgery pain assessments at home and returned their pain diaries. Of these 69 parents, 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was likely to be administered (χ=21.4; P<.001), with a medicinal intervention being 12.6 (95% CI 4.3-37.0; P<.001) times more likely and a nonmedicinal intervention being 5.2 (95% CI 1.8-14.6; P=.002) times more likely than no intervention. In the presence of intervention, score cutoff values were ≥2 for PainChek Infant and ≥20 for ObsVAS. A significant effect between the use of the pain instrument (χ=7.2, P=.007) and intervention (χ=43.4, P<.001) was found, supporting the construct validity of both instruments. Standardized pain scores were the highest when a medicinal intervention was undertaken (estimated marginal mean [EMM]=34.2%), followed by a nonmedicinal intervention (EMM=23.5%) and no intervention (EMM=11.2%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5% (224/237) of assessments where parents undertook an intervention. In 75.1% (178/237) of assessments indicative of pain, the score changed from pain to no pain, with PainChek Infant assessments more likely to report this change (odds ratio 4.1, 95% CI 1.4-12.3) compared with ObsVAS assessments.
The use of standardized pain assessment instruments by parents at home to assess pain in their infants can inform their decision-making regarding pain identification and management, including determining the effectiveness of the chosen intervention. In addition to the construct validity and clinical utility of PainChek Infant and ObsVAS in this setting, feeding alone and a combination of feeding with medication use were the key pain intervention strategies used by parents.
由于婴儿无法用言语表达，因此无法自我报告疼痛，所以对婴儿群体进行疼痛评估具有挑战性。目前，关于父母如何使用标准化疼痛评估工具在家中识别和处理这种疼痛的数据很少。
本研究旨在使用标准化疼痛评估工具，探讨父母在婴儿同日手术后在家中对其疼痛的评估和干预情况。
这项前瞻性研究最初招募了109名接受包皮环切术（同日手术）的男婴。为了评估术后3天在家中的疼痛情况，使用iOS设备的父母被分配使用PainChek Infant工具，这是一种即时护理人工智能工具，而使用安卓设备的父母被分配使用观察者管理视觉模拟量表（ObsVAS）工具。卡方分析比较了所采取的干预措施和疼痛情况。广义估计方程用于评估与结构效度和临床效用相关的结果。受试者工作特征分析评估了与所用干预措施相关的疼痛评分临界值。
共有69名父母在家中完成了术后疼痛评估并返回了他们的疼痛日记。在这69名父母中，24人使用ObsVAS，45人使用PainChek Infant。仅喂养和药物喂养是最常见的疼痛干预措施。随着时间的推移，疼痛情况有所减轻。在存在疼痛的情况下，很可能会采取干预措施（χ=21.4；P<.001），药物干预的可能性是不采取干预措施的12.6倍（95%可信区间4.3-37.0；P<.001），非药物干预的可能性是不采取干预措施的5.2倍（95%可信区间1.8-14.6；P=.002）。在存在干预措施的情况下，PainChek Infant的评分临界值≥2，ObsVAS的评分临界值≥20。发现疼痛工具的使用（χ=7.2，P=.007）和干预措施（χ=43.4，P<.001）之间存在显著影响，支持了两种工具的结构效度。当采取药物干预措施时标准化疼痛评分最高（估计边际均值[EMM]=34.2%），其次是非药物干预措施（EMM=23.5%）和不采取干预措施（EMM=11.2%）。两种疼痛工具都出现了类似趋势。在父母采取干预措施的评估中，94.5%（224/237）的疼痛情况有所减轻。在75.1%（178/237）表明存在疼痛的评估中，评分从疼痛变为无疼痛，与ObsVAS评估相比，PainChek Infant评估更有可能报告这种变化（优势比4.1，95%可信区间1.4-12.3）。
父母在家中使用标准化疼痛评估工具来评估婴儿的疼痛，可以为他们在疼痛识别和管理方面的决策提供信息，包括确定所选干预措施的有效性。除了PainChek Infant和ObsVAS在这种情况下的结构效度和临床效用外，仅喂养以及喂养与药物使用相结合是父母使用的关键疼痛干预策略。
