The Validity of Skin Conductance For Assessing Acute Pain in Infants

Abstract

Objectives: Measuring pain in infants is important but challenging, as there is no “gold standard.” The measurement of skin conductance (SC) is considered to be a measure of stress and as a surrogate indicator of pain. The objectives of this study were to identify the extent of research conducted and to synthesize the validity evidence of SC for assessing acute pain in infants. Methods: The Arksey and O’Malley framework for scoping reviews was followed, and 9 electronic databases were searched. Data were analyzed thematically and presented descriptively including the following main categories: study information/details, sampling information, characteristics of participants and settings, SC outcome measures, and validity evidence. Results: Twenty-eight studies with 1061 infants were included, including 23 cross-sectional observation studies and 5 interventional studies. The most studied infants were those with mild severity of illness (n=13) or healthy infants (n=12). The validity evidence of SC was tested in relation to referent pain measures (13 variables), stimuli (13 variables), age (2 variables), and other contextual variables (11 variables). SC was not significantly correlated with vital signs, except for heart rate in 2 of the 8 studies. SC was significantly correlated with the unidimensional behavioral pain assessment scales and crying time rather than with multidimensional measurements. Fourteen of 15 studies (93.3%) showed that SC increased significantly during painful procedures. Conclusions: Inconsistent findings on validity of SC exist. Future research should aim to identify the diagnostic test accuracy of SC compared with well-accepted referent pain measures in infants, study the validity evidence of SC in critically ill infants, and utilize rigorous research design and transparent reporting.

Study protocol: parents as pain management in Swedish neonatal care – SWEpap, a multi-center randomized controlled trial

“…Secondary outcomes in the RCT are: a) changes in galvanic skin response (GSR) (area small peaks, area huge peaks, peaks per second, average rise time, average peak), which is obtained via three electrodes on the infant's foot [52], b) parents' rating of the infant's pain, c) parents' rating of their own stress during the procedure and d) parents' rating of how beneficial the pain management they were involved in felt to them and their infant.…”

“…As an indicator of pain, skin conductance measurements have detected increased sweating in newborn infants < 28 + 0 postnatal age submitted to heel lancing [53]. GSR have been tested in several neonatal pain studies on term and preterm infants, measuring skin conductance that reflects pain-related activation of the sympathetic nervous system [52][53][54][55]. Analyses of GSR are presented with the following variables; area small peaks, area huge peaks (both representing forcefulness of sympathetic nerve firing), peaks per second (the rate of firing in the sympathetic nerves), average rise time, average peak.…”

“…Analyses of GSR are presented with the following variables; area small peaks, area huge peaks (both representing forcefulness of sympathetic nerve firing), peaks per second (the rate of firing in the sympathetic nerves), average rise time, average peak. Higher values in any of the above GSR parameters are indicative of more stress [52].…”

The validity of skin conductance for assessing acute pain in mechanically ventilated infants: A cross‐sectional observational study

“…Additionally, the scores of SC can be easily and quickly understood by clinicians and researchers. The number of SC waves per second (NWps) was recommended by many previous studies and the user manual of SC device for pain assessment (Hu et al, 2019;Med-Storm Innovation AS, 2012).…”

“…A recent scoping review, which included 28 studies with 1,061 infants, synthesized the validity of SC for assessing acute pain in hospitalized infants (Hu et al, 2019). The results showed that SC might be a promising pain assessment method in infants.…”