Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain
Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain
复制标题
DOI：
10.1038/sj.jp.7211861
复制
发表时间：
2008-01-01
影响因子：
2.9
通讯作者：
Weiss, M. G.
中科院分区：
文献类型：
--
作者：
Hummel, P.;Puchalski, M.;Weiss, M. G.
目的：建立新生儿疼痛、躁动和镇静量表（N-PASS）在新生儿术后和机械通气中持续疼痛的临床有效性和可靠性的初步证据。研究设计：前瞻性心理测量评估。两名护士在疼痛或镇静药物干预前后同时独立使用N-PASS。一名护士还在进行N-PASS的同时进行了早产儿疼痛概况（PIPP）。设置包括50张床位的三级新生儿重症监护病房。本研究采用72例便利样本，对46例0 ~ 100日龄、胎龄23 ~ 40周的通气和/或术后婴儿进行观察。结果测量包括收敛效度、结构效度、互信度和内部一致性。结果：用类内系数0.85 ~ 0.95测量的量表间信度较高（P < 0.001 ~ 0.0001）。通过与PIPP评分的相关性证明了收敛效度（高疼痛评分的Spearman等级相关系数为0.83，低疼痛评分的Spearman等级相关系数为0.61）。内部一致性，通过Cronbach's a测量，疼痛评分（0.82）和镇静评分（0.87）明显。通过Wilcoxon符号秩检验建立结构效度，比较药物干预前后N-PASS评分的分布，干预前后疼痛评分分别为4.86（3.38）和1.81(1.53)（平均（s. d.）， P < 0.0001），镇静评分分别为0.85（1.66）和-2.78 (2.81)（P < 0.0001）。结论：本研究提供了初步证据，证明N-PASS是评估0 ~ 100天龄、妊娠23周及以上的通气和/或术后婴儿疼痛/躁动和镇静的有效和可靠的工具。
Objective: To establish beginning evidence of clinical validity and reliability of the Neonatal Pain, Agitation and Sedation Scale (N-PASS) in neonates with prolonged pain postoperatively and during mechanical ventilation. Study Design: Prospective psychometric evaluation. Two nurses administered the N-PASS simultaneously and independently before and after pharmacologic interventions for pain or sedation. One nurse also administered the premature infant pain profile (PIPP) concurrently with the N-PASS. The setting consisted of 50-bed level III neonatal intensive care unit. Convenience sample of 72 observations of 46 ventilated and/ or postoperative infants, 0 to 100 days of age, gestational age 23 to 40 weeks was used. Outcome measures comprised convergent and construct validity, interrater reliability and internal consistency. Result: Interrater reliability measured by intraclass coefficients of 0.85 to 0.95 was high (P < 0.001 to 0.0001). Convergent validity was demonstrated by correlation with the PIPP scores (Spearman's rank correlation coefficient of 0.83 at high pain scores, 0.61 at low pain scores). Internal consistency, measured by Cronbach's a, was evident with pain scores (0.82), and with sedation scores (0.87). Construct validity was established via the Wilcoxon signed-rank test, comparing the distribution of N-PASS scores before and after pharmacologic intervention showing pain scores of 4.86 (3.38) and 1.81 (1.53) (mean (s. d.), P < 0.0001) and sedation scores of 0.85 (1.66) and -2.78 (2.81) (P < 0.0001) for pre- and postintervention assessments, respectively. Conclusions: This research provides beginning evidence that the N-PASS is a valid and reliable tool for assessing pain/agitation and sedation in ventilated and/ or postoperative infants 0 to 100 days of age, and 23 weeks gestation and above.