Pain indicators for persisting pain in hospitalized infants in a South African setting: an explorative study

Abstract

In the developing world, there is a high incidence of human immunodeficiency virus (HIV), gastroenteritis, pneumonia, meningitis, and other inflammatory diseases in infants, the conditions of which may induce persisting pain. The primary objective was to estimate the reliability and validity of the Touch Visual Pain (TVP) scale to measure persisting pain. This prospective observational study was performed in hospitalized 0-3-year-old infants in South Africa. The Numeric Rating Scale (NRS) pain, NRS distress, and the TVP scale were applied and scores were compared. The TVP scale consists of 10 behavioral indicators scored as present or not present. Associations between the different scales were tested with logistic regression analyses. We analyzed 337 assessments in 151 patients. The NRS pain score was 4 or higher in 82 (24%) assessments. The NRS distress score was 4 or higher in 242 (72%) assessments. The mean TVP score was 3.7 (SD = 1.6). Four TVP items were statistically significantly associated with NRS pain; three other TVP items with NRS distress. The behaviors "cry/moaning" and "alertness" were also significantly associated with NRS distress. Two TVP items were not sensitive to assess pain or distress and were replaced in a revised TVP version. We conclude that our study identified sensitive and specific indicators of persisting pain in hospitalized children under the age of 3 years in a South African setting. Psychometric properties of the revised TVP need to be studied before its use in clinical practice can be recommended.

Keywords: pain assessment instrument, children, persistent pain, developing world.