JMIR Publications

ABSTRACT

Background:

Pain assessment in the infant population group is challenging due to their inability to verbalize and hence self-report pain. Currently there is paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools.

Objective:

Explore parents’ pain assessment and interventions in their infant at home following same-day surgery using standardized pain assessment tools.

Methods:

In this prospective study, 109 infant boys undergoing circumcision procedure were initially recruited for the study, prior to undergoing same-day surgery. To assess pain at home over three days post-surgery, parents using an iOS device were educated and allocated to use PainChek Infant, which is a point-of-care artificial intelligence-enabled tool whereas android device users were allocated to use the ObsVAS instrument. Chi-square analysis compared intervention undertaken and pain presence. Generalized estimating equations were used to evaluate construct validity and clinical utility related outcomes. Receiver Operator Characteristic assessed pain score cutoffs in relation to intervention.

Results:

A total of 69 parents completed post-surgery pain assessment at home and returned their pain diaries, of which 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was more likely (χ2=21.4, p<0.001) with medicinal intervention being 12.6 (OR CI 4.3-37.0 p<0.001) times more likely to occur whilst a non-medicinal intervention was 5.2 (OR CI 1.8-14.6, p=0.002) times more likely than no intervention. In the presence of intervention, score cut-off value for PainChek Infant was ≥2 and ≥20 for VAS. A significant effect between use of pain instrument (χ2=7.2, p=0.007) and intervention (χ2=43.4, p<0.001) was found, supporting construct validity of both instruments. Standardized pain scores were highest when a medicinal intervention was undertaken (EMM=34.2%) followed by non-medicinal intervention (EMM=23.5%) and no intervention (EMM=11.2%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5% (n=224) of assessments where parents undertook an intervention. In 75.1% (n=178) of assessments indicative of pain, score changed from pain to no pain with PainChek infant assessments more likely to report this change (OR=4.1, CI 1.4-12.3) compared to the ObsVAS tool.

Conclusions:

Use of standardized pain assessment instruments by parents at home to assess pain in their infant can inform their decision-making around pain identification and management, including determining effectiveness of the chosen intervention. In addition to construct validity and clinical utility of Painchek Infant and ObsVAS in this setting, feeding alone followed by a combination of feeding with medication use were the key pain intervention strategies used by parents.