A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit

Objective: The aim of this study was to validate a clinician-friendly pain assessment tool for all groups of critically ill infants cared for in the specific neonatal intensive care units (NICUs) studied. Design: A prospective study was undertaken to test the Pain Assessment Tool (PAT). Interrater reliability of the PAT score was assessed by two nurses who simultaneously determined an infant's PAT score. The PAT was validated against the CRIES score—crying, requires increased oxygen administration, increased vital signs, expression, sleeplessness—and the mother's assessment of her infant's discomfort using the Visual Analogue Scale (VAS). Setting: The NICUs at two children's hospitals. Patients: Participants were 144 preterm and term infants. Infants on a ventilator and those who had undergone surgery were included. Results: The interrater reliability of the PAT was .85 with a mean difference of 0.17 (standard deviation: 1.73). There was a strong correlation between the PAT and CRIES scores (r = 0.76) and a moderate correlation (.38) between the PAT score and the VAS scores of the infant's mother. The correlation coefficient between the PAT score and CRIES score was significant for all groups (p < .01). Conclusions: The PAT score was shown in this study to be a valid, reliable, and clinician-friendly pain assessment measurement tool for all infants nursed in the NICU.