Abstract
Aim: Inadequate assessment of pain may be due to lack of an easy reliable scale. We developed and validated a pain scale (ABC scale) for term babies based on acoustic features of crying.
Methods: The scale consisted of three different cry parameters: a) pitch of the first cry; b) rhythmicity of the crying bout; c) continuity of the crying. These parameters were previously found to be correlated with pain level by spectral analysis of crying. We validated the scale using 90 healthy term babies undergoing routine heelprick. To assess its sensitivity we examined the distribution of the ABC scores in the seven levels (0–6) of the scale in 50 babies. Concurrent validity was assessed comparing pain values obtained with our scale with those obtained with another pain scale in the same group of babies. To assess specificity we compared the ABC scores during a heelprick performed without analgesia with those of the preliminary phase in a group of 20 babies, and then with those of another group of 20 babies who received analgesia during heelprick. To assess inter-rater reliability and the internal consistency of the scale items, we asked four neonatal nurses to score 28 crying episodes recorded during routine heel-pricks. To assess the intra-rater reliability, they scored these cries a second time, at a distance of two months. To assess feasibility of the scale we asked them to use it for a 10 day period during painful procedures and analysed their approval or disapproval.
Results: Sensitivity and specificity: a) analgesic/non analgesic comparison p<0.0001; b) pain/sham comparison: p<0.0001). Concurrent validity: Spearman rho= 0.91. Internal consistency: Cronbach's alfa= 0.76. Inter -rater reliability: Cohen's kappa for multiple raters = 0.83. Intra-rater reliability: Cohen's kappa = 0.85. All nurses that used it, defined the scale “good”.
Conclusion: The ABC scale proved to be simple and reliable for assessing pain in healthy non intubated term newborns.
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Bellieni, C., Sisto, R., Neri, L. et al. 26 Validation of A New Clinical Pain Scale for Full-Term Babies. Pediatr Res 56, 468 (2004). https://doi.org/10.1203/00006450-200409000-00049
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DOI: https://doi.org/10.1203/00006450-200409000-00049