How reliably can clinicians tell whether a baby is in pain when the baby cannot say so?

Details

Identifying pain in infants is challenging because they cannot self-report it, making valid and reliable ways to assess pain critical. This meta-review sought evidence to guide the selection of appropriate pain assessment tools for this vulnerable population.

The researchers searched Scopus, Medline, Embase, CINAHL, MIDRIS, EMCare and Google Scholar for eligible systematic reviews. Reviews were eligible if they documented the psychometric properties of available observational tools used to assess pain in infants.

Of 516 reviews identified, 11 met the inclusion criteria. These 11 reviews evaluated 36 pain assessment tools; seven tools were reported in at least three reviews. Evidence on the tools’ psychometric properties varied widely, with reported reliability and validity ranging from low to good. Data on usability and clinical utility were limited.

The authors concluded that no observer-administered pain assessment tool can currently be recommended as the gold standard because the evidence supporting validity, reliability and clinical utility is limited in availability and quality. The meta-review brings together available evidence to help clinicians choose the most appropriate tool for their clinical practice setting. The authors emphasized that researchers need a standardized approach to evaluating both psychometric properties and clinical utility so that tool selection can be guided by the highest level of evidence.