A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations
A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations
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DOI：
10.1016/j.pain.2009.05.012
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发表时间：
2009-09-01
期刊：
影响因子：
7.4
通讯作者：
Capdevila, Xavier
中科院分区：
文献类型：
--
作者：
Bringuier, Sophie;Picot, Marie-Christine;Capdevila, Xavier
采用4种行为评定量表(Cheops、Chipps、Flacc和OPS)对1~7岁儿童术后疼痛进行评定，比较其心理测量学特征、敏感性和特异性。包括在这项前瞻性纵向研究中的150名儿童被拍摄下来，以回顾分析围手术期的行为。疼痛和焦虑由孩子或他们的父母前瞻性地评估。在研究结束时，四名观察者使用四个BR对围手术期视频进行评分。由于自我报告并不适用于所有的儿童，因此从视频中分析疼痛的面部表情，以产生面部动作总结分数(FASS)，作为研究四种BRS的效度的参考。内部效度良好，但外部效度参差不齐。Flacc似乎更适合于评估1至7岁儿童的术后疼痛。然而，它与焦虑程度显著相关。此外，使用疼痛自我报告和FASS对敏感度和特异度的分析表明，一些儿童仍然被低估。多变量分析强调沉默是误判术后疼痛的高危因素。总而言之，这项研究强调了在使用四种BRS时区分疼痛强度和焦虑的难度，以及术后近十分之一的儿童被错误评估。(C)2009年国际疼痛研究协会。爱思唯尔出版，版权所有。
Four behavioral rating scales (BRS) (CHEOPS, CHIPPS, FLACC and OPS) assessing postoperative pain in children aged 1-7 years were studied to compare their psychometric properties, sensitivity and specificity. One hundred and fifty children included in this prospective longitudinal study were videotaped to analyze retrospectively peri-operative behaviors. Pain and anxiety were evaluated by children or by their parents prospectively. At the end of the study, four observers rated the peri-operative videos using the four BRS. Because self-reporting cannot be used for all the children, facial expression of pain was analyzed from the videos to create a Facial Action Summary Score (FASS) which was considered as a reference for the study of validity of the four BRS. Internal validities were excellent but external validities were mixed. The FLACC seems to be better adapted to assess post-surgical pain in children between 1 and 7 years old. Nevertheless, it was significantly correlated with anxiety measures. Moreover, the analysis of sensitivity and specificity using both self-reporting of pain and FASS showed that some children were still under-evaluated. The multivariate analysis underlines silence as a high risk factor of misevaluating postoperative pain. In conclusion, this study highlights the difficulty of discriminating pain intensity from anxiety when using the four BRS and that postoperatively, nearly one child in 10 was misevaluated. (C) 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.