Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200194
Brazilian Journal of Pain
Original Article

Inter-observer agreement in the identification of pain faces in full-term and late preterm newborns: cross-sectional study

Concordância interavaliadores na identificação de faces de dor de recém-nascidos a termo e pré-termo tardio: estudo transversal

Tatiany Marcondes Heiderich; Marina Carvalho de Moraes Barros; Ruth Guinsburg

Downloads: 0
Views: 378

Abstract

BACKGROUND AND OBJECTIVES: Difficulty in neonatal assessment is a challenge for the development of pain prevention and treatment strategies. The objective of this study was to analyze the agreement among health professionals in the identification of facial pain movements in images of neonates submitted or not to a painful procedure and to evaluate the discriminatory capacity of these facial movements regarding the presence of pain.

METHODS: Cross-sectional study. Six health professionals trained in neonatal pain assessment evaluated 30 images of newborns undergoing a painful procedure and 30 images of the same newborns at rest, without pain. Each professional evaluated five facial movements that are part of the Neonatal Facial Coding System. Sensitivity, specificity, and positive and negative predictive values were determined. Agreement among professionals was assessed using the kappa coefficient.

RESULTS: The six observers correctly assessed 94±9% of the images obtained at rest as absence of pain and 88±28% of the images obtained during the painful procedure as presence of pain. Protruding forehead, narrowed eyelid cleft, deepened nasolabial furrow, and open mouth showed high sensitivity, specificity, and positive and negative predictive values in the diagnosis of pain, with values between 78-90%. The inter-observer agreement for all 60 images showed a kappa coefficient of 0.60 (95%CI 0.55-0.66).

CONCLUSION: The evaluation of the forehead, eyelid, nasolabial furrow and mouth of newborns showed high sensitivity and specificity to discriminate the presence and absence of pain in static images. The agreement between the evaluators in identifying facial movements related to the expression of pain in newborns was moderate.

Keywords

Facial expression, Newborn, Observer variation, Pain measurement

Resumo

JUSTIFICATIVA E OBJETIVOS: A dificuldade na avaliação da dor do recém-nascido é um desafio para o desenvolvimento de estratégias de prevenção e tratamento da dor. O objetivo deste estudo foi analisar a concordância entre profissionais de saúde na identificação de movimentos faciais de dor em imagens de recém-nascidos submetidos ou não a um procedimento doloroso e a capacidade discriminatória quanto à presença de dor desses movimentos faciais.

MÉTODOS: Estudo transversal. Seis profissionais de saúde treinados na avaliação da dor neonatal avaliaram 30 imagens de recém-nascidos submetidos a um procedimento doloroso e 30 imagens em repouso dos mesmos recém-nascidos, sem dor. Cada profissional avaliou cinco movimentos faciais que fazem parte do Sistema de Codificação Facial Neonatal. Sensibilidade, especificidade e valores preditivos positivos e negativos foram determinados. A concordância interavaliadores foi avaliada pelo coeficiente kappa.

RESULTADOS: Os seis observadores avaliaram corretamente 94±9% das imagens obtidas em repouso como ausência de dor e 88±28% das imagens obtidas durante o procedimento doloroso como presença de dor. Fronte saliente, fenda palpebral estreitada, sulco nasolabial aprofundado e boca aberta mostraram alta sensibilidade, especificidade e valores preditivos positivo e negativo no diagnóstico de dor, com valores entre 78 e 90%. A concordância interavaliadores para todas as 60 imagens mostrou um kappa 0,60 (IC95%0,55-0,66).

CONCLUSÃO: A avaliação da fronte, pálpebra, sulco nasolabial e boca de recém-nascidos mostrou alta sensibilidade e especificidade para discriminar a presença e ausência de dor em imagens estáticas. A concordância interavaliadores na identificação de movimentos faciais relacionados à expressão da dor em recém- -nascidos foi moderada.

Palavras-chave

Expressão facial, Medição da dor, Recém-nascido, Variações dependentes do observador

References

Marchant A. 'Neonates do not feel pain': a critical review of the evidence. Biosci Horizons. 2014;7:1-9.

Cong X, McGrath JM, Cusson RM, Zhang D. Pain assessment and measurement in neonates: an updated review. Adv Neonatal Care. 2013;13(6):379-95.

Efe E, Dikmen S, Altas N, Boneval C. Turkish pediatric surgical nurses' knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns' pain relief. Pain Manag Nurs. 2013;14(4):343-50.

Laudiano-Dray MP, Pillai Riddell R, Jones L, Iyer J, Whitehead K, Fitzgeral M. Quantification of neonatal procedural pain severity: a platform for estimating total pain burden in individual infants. Pain. 2020;161(6):1270-7.

Grunau RE, Oberlander T, Holsti L, Whitfield MF. Bedside application of the Neonatal Facial Coding System in pain assessment of premature neonates. Pain. 1998;76(3):277-86.

Stevens B, Johnston C, Petryshen P, Taddio A. Premature Infant Pain Profile: development and initial validation. Clin J Pain. 1996;12(1):13-22.

Silva TP, Silva LJ. Escalas de avaliação da dor utilizadas no recém-nascido: revisão sistemática. Acta Med Port. 2010;23:437-54.

Hadjistavropoolos HD, Craig KD, Grunau RV, Johnston CC. Judging pain in newborns: facial and cry determinants. J Pediatr Pysichol. 1994;19(4):485-91.

Grunau R, Johnston C, Craig K. Neonatal facial and cry responses to invasive and non-invasive procedures. Pain. 1990;42(3):295-305.

Grunau RV, Craig KD. Pain expression in neonates: facial action and cry. Pain. 1987;28(3):395-410.

Craig KD, Whitfield MF, Grunau RV, Hadjistavropoulos HD. Pain in the preterm neonate: behavioural and physiological indices. Pain. 1993;52(3):287-99.

Chen Z, Ansari R, Wilkie D. Learning pain from action unit combinations: a weakly supervised approach via multiple instance learning. IEEE Trans Affect Comput. 2019.

Ahola Kohut S, Pillai Riddell R, Flora DB, Oster H. A longitudinal analysis of the development of infant facial expressions in response to acute pain: immediate and regulatory expressions. Pain. 2012;153(12):2458-65.

Peters JW, Koot HM, Grunau RE, Boer J, van Druenen MJ, Tibboel D. Neonatal Facial Coding System for assessing postoperative pain in infants: item reduction is valid and feasible. Clin J Pain. 2003;19(6):353-63.

Rushforth JA, Levene MI. Behavioural response to pain in healthy neonates. Arch Dis Child Fetal. 1994;70(3):F174-6.

Silva YP, Gomez RS, Máximo TA, Silva AC. Avaliação da dor em neonatologia. Rev Bras Anestesiol. 2007;57(5):565-74.

Caetano EA, Lemos NR, Cordeiro S, Pereira FM, Moreira DS, Buchhorn SM. O recém-nascido com dor: atuação da equipe de enfermagem. Esc Anna Nery. 2013;17(3):439-45.

Bueno M, Stevens B, Barwick MA, Riahi S, Li SA, Lanese A. A cluster randomized clinical trial to evaluate the effectiveness of the Implementation of Infant Pain Practice Change (ImPaC) Resource to improve pain practices in hospitalized infants: a study protocol. Trials. 2020;21(1):16.

Balice-Bourgois C, Zumstein-Shaha M, Vanoni F, Jaques C, Newman CJ, Simonetti GD. A systematic review of clinical practice guidelines for acute procedural pain on neonates. Clin J Pain. 2020;36(5):390-8.

Maciel HIA, Costa MF, Costa ACL, Marcatto JO, Manzo BF, Bueno M. Medidas farmacológicas e não farmacológicas de controle e tratamento da dor em recém-nascidos. Rev Bras Ter Intensiva. 2019;31(1):21-6.

Hills E, Rosenberg J, Banfield N, Harding C. A multidisciplinary approach to the implementation of non-pharmacological strategies to manage infant pain. Infant. 2020;16(2):78-81.

Pinheiro IO, Lima FE, Magalhães FJ, Farias LM, Sherlock MS. Pain evaluation in newborns using the Neonatal Facial Activity Coding scale during blood gases analysis. Rev Dor. 2015;16(3):176-80.

Cardoso TA, Rocha RSB, Cunha KC. Influência da utilização da glicose 0,25% na avaliação da dor neonatal em prematuros tardios submetidos a fisioterapia respiratória. Rev Para Med. 2014;28(3):43-8.

Hu J, Ruan H, Li Q, Gifford W, Zhou Y, Yu L, Harrison D. Barriers and facilitators to effective procedural pain treatments for pediatric patients in the Chinese contexto: a qualitative descriptive study. J Pediatr Nurs. 2020;54:78-85.

Martins SW, Enumo SRF, Paula KMP. Manejo da dor neonatal: influência de fatores psicológicos e organizacionais. Estud Psicol. 2016;33(4):633-44.

Heiderich TM, Leslie AT, Giomsburg R. Neonatal procedural pain can be assessed by computer software that has good sensitivity and specificity to detect facial movements. Acta Paediatr. 2015;104(2):e63-9.

Hale CA, Fleiss JL. Interval estimation under two study designs for kappa with binary classifications. Biometrics. 1993;49(2):523-34.

Randolph JJ. Online Kappa Calculator [Computer software]. Advances in Data Analysis and Classification. 2008.

Kappesser J, de Laffolie J, Faas D, Ehrhardt H, Herman C. Comparison of two neonatal pain assessment tools (Children and Infant's Postoperative Pain Scale and the Neonatal Facial Coding System-Revised) and their relations to clinicians' intuitive pain estimates. Eur J Pain. 2019;23(4):708-18.

DiLorenzo MG, Pillai Riddell R, Flora DB, Craig KD. Infant Clinical Pain Assessment: core behavioral cues. J Pain. 2018;19(9):1024-32.


Submitted date:
06/18/2020

Accepted date:
08/11/2020

608730c4a95395602670f114 brjp Articles

BrJP

Share this page
Page Sections