Chambers C T, Reid G J, Craig K D, McGrath P J, Finley G A
Department of Psychology, IWK-Grace Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Clin J Pain. 1998 Dec;14(4):336-42. doi: 10.1097/00002508-199812000-00011.
Parents are often the primary source of information regarding their children's pain in both research and clinical practice. However, parent-child agreement on pain ratings has not been well established. The objective of the present study was to examine agreement between child- and parent-rated pain following minor surgery.
Tertiary care children's hospital.
A total of 110 children (56.4% male) aged 7-12 years undergoing surgery and their parents.
Parents and children independently rated pain intensity by using a 7-point Faces Pain Scale on the day of the child's surgery and the following 2 days.
Correlations (both Pearson's and intraclass correlation coefficients) indicated a highly significant relationship between child and parent ratings. However, kappa statistics indicated only poor to fair agreement beyond chance. Parents tended to underestimate their children's pain on the day of surgery and the following day, but not on the second day following surgery. When children's and parents' pain ratings for each of the 3 days were collapsed into a no-pain/low-pain group or a clinically significant pain group, kappa statistics indicated fair to good agreement. Parents demonstrated low levels of sensitivity in identifying when their children were experiencing clinically significant pain.
Correlations between parent and child pain reports do not accurately represent the relationship between these ratings and in fact overestimate the strength of the relationship. Parents' underestimation of their child's pain may contribute to inadequate pain control.
在研究和临床实践中，父母通常是孩子疼痛信息的主要来源。然而，亲子之间在疼痛评分上的一致性尚未得到充分确立。本研究的目的是检查小儿手术后孩子自评与父母评定的疼痛之间的一致性。
三级护理儿童医院。
总共110名7至12岁接受手术的儿童（56.4%为男性）及其父母。
父母和孩子在孩子手术当天及随后两天，通过使用7分面部疼痛量表独立评定疼痛强度。
相关性分析（皮尔逊相关系数和组内相关系数）表明孩子与父母的评分之间存在高度显著的关系。然而，kappa统计显示，除偶然因素外，一致性仅为差到中等。父母往往在手术当天及第二天低估孩子的疼痛，但在术后第二天没有。当将孩子和父母在这三天中每一天的疼痛评分合并为无疼痛/低疼痛组或具有临床意义的疼痛组时，kappa统计显示一致性为中等至良好。父母在识别孩子何时经历具有临床意义的疼痛方面表现出较低的敏感性。
父母与孩子的疼痛报告之间的相关性并不能准确反映这些评分之间的关系，实际上高估了这种关系的强度。父母对孩子疼痛的低估可能导致疼痛控制不足。
