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

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

doi:10.5935/2595-0118.20200194

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

http://dx.doi.org/10.5935/2595-0118.20200194 BrJP, vol.3, n4, p.348-353, 2020

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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

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Submitted date:
06/18/2020

Accepted date:
08/11/2020

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

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