Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants

Abstract

Objective-To develop and validate a scale suitable for use in clinical practice as a tool for assessing prolonged pain in premature infants. Methods-Pain indicators identified by observation of preterm infants and selected by a panel of experts were used to develop the EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale). A cohort of preterm infants was studied prospectively to determine construct validity, inter-rater reliability, and internal consistency of the scale. Results-The EDIN scale uses five behavioural indicators of prolonged pain: facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability. The validation study included 76 preterm infants with a mean gestational age of 31.5 weeks. Inter-rater reliability was acceptable, with a coeYcient range of 0.59-0.74. Internal consistency was high: Cronbach's coeYcients calculated after deleting each item ranged from 0.86 to 0.94. To establish construct validity, EDIN scores in two extreme situations (pain and no pain) were compared, and a significant diVerence was observed. Conclusions-The validation data suggest that the EDIN is appropriate for assessing prolonged pain in preterm infants. Further studies are warranted to obtain further evidence of construct validity by comparing scores in less extreme situations. (Arch Dis Child Fetal Neonatal Ed 2001;85:F36-F41)

Prevention and Management of Pain in the Neonate: An Update

“…27 The most commonly used assessment tools are listed in Table 1. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] For each tool, the physiologic and behavioral indicators of pain are described, the population for which they have been validated are delineated, and unique aspects are listed. Whatever assessment tools are used, continual multidisciplinary training of staff in the recognition of neonatal pain and in the use of the chosen pain-assessment tools should be provided.…”

Validação da Échelle Douleur Inconfort Nouveau-Né para a cultura brasileira

“…In order to establish the measurement properties of the instrument, reliability was assessed by homogeneity (0.92) and equivalence (0.59-0.74), while the construct validity was evaluated in two ways: 1) in 40 preterm neonates with respiratory distress syndrome, in which the mean EDIN score before analgesia of 9.2 (SD=1.7) was correlated with the mean of the total instrument score after fentanyl infusion for eight hours 4.7 (2.1) (p < 0.0001); and 2) in 36 neonates admitted to an Intermediate Care Unit (IMCU), where the instrument was applied on the day of admission 4.5 (SD=3.7) and one day before discharge 1.5 (1.5) (p=0.0009). These differences suggest that EDIN is a valid and reliable scale that is able to distinguish situations of pain and absence of pain in preterm neonates (5) . The instrument's authors do not determine a minimum recommended period of observation for assessing pain, but the EDIN should be applied after several hours of contact with the neonates and not in a timely manner (5) in order to allow a more consistent evaluation of parameters such as sleep and consolability.…”

“…These differences suggest that EDIN is a valid and reliable scale that is able to distinguish situations of pain and absence of pain in preterm neonates (5) . The instrument's authors do not determine a minimum recommended period of observation for assessing pain, but the EDIN should be applied after several hours of contact with the neonates and not in a timely manner (5) in order to allow a more consistent evaluation of parameters such as sleep and consolability. Another interesting point of the scale is that for the items related to facial expression and body movement, there is an option for a response of "no expression or body movement", which may reflect an energy conservation mechanism and not necessarily the absence of pain (6) ; an important consideration, especially regarding preterm neonates.…”

“…The possibility of assigning a numerical score to an abstract concept allows for establishing effective communication language between the observer and the observed, guiding the interventions (4) . The Échelle Douleur Inconfort Nouveau-Né (EDIN) was the first scale developed for assessing prolonged pain in preterm neonates (5) . Few studies have been developed with the purpose of increasing knowledge about prolonged neonatal pain, and there is still no consensus on definitions for prolonged, continuous and chronic pain for these patients.…”

“…Despite the lack of consensus, there is no doubt that the suffering of neonates admitted to NICU goes beyond acute pain (6) . The EDIN was developed based on studies with expert panels that grouped the signals expressed by neonates into different indicators after 2 consecutive years of observing them in potentially painful situations: Facial activity, Body movements, Quality of sleep, Quality of contact and Consolability (5,7) . These exclusively behavioral parameters have been described considering that they are more sensitive and specific for measuring prolonged pain, since physiological alterations may not be present in this type of pain since they are not maintained for long periods (6) .…”