Neonatal Facial Coding System for assessing postoperative pain in infants: item reduction is valid and feasible.
OBJECTIVE
The objectives of this study were to: (1). evaluate the validity of the Neonatal Facial Coding System (NFCS) for assessment of postoperative pain and (2). explore whether the number of NFCS facial actions could be reduced for assessing postoperative pain.


METHODS
Prospective, observational study.


METHODS
Thirty-seven children (0-18 months old) undergoing major abdominal or thoracic surgery.


METHODS
The outcome measures were the NFCS, COMFORT "behavior" scale, and a Visual Analog Scale (VAS), as well as heart rate, blood pressure, and catecholamine and morphine plasma concentrations. At 3-hour intervals during the first 24 hours after surgery, nurses recorded the children's heart rates and blood pressures and assigned COMFORT "behavior" and VAS scores. Simultaneously we videotaped the children's faces for NFCS coding. Plasma concentrations of catecholamine, morphine, and its metabolite M6G were determined just after surgery, and at 6, 12, and 24 hours postoperatively.


RESULTS
All 10 NFCS items were combined into a single index of pain. This index was significantly associated with COMFORT "behavior" and VAS scores, and with heart rate and blood pressure, but not with catecholamine, morphine, or M6G plasma concentrations. Multidimensional scaling revealed that brow bulge, eye squeeze, nasolabial furrow, horizontal mouth stretch, and taut tongue could be combined into a reduced measure of pain. The remaining items were not interrelated. This reduced NFCS measure was also significantly associated with COMFORT "behavior" and VAS scores, and with heart rate and blood pressure, but not with the catecholamine, morphine, or M6G plasma concentrations.


CONCLUSIONS
This study demonstrates that the NFCS is a reliable, feasible, and valid tool for assessing postoperative pain. The reduction of the NFCS to 5 items increases the specificity for pain assessment without reducing the sensitivity and validity for detecting changes in pain.
Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands. j.peters@erasmusmc.nl
Jeroen W B
JW
Peters
Hans M
HM
Koot
Ruth E
RE
Grunau
Josien
J
de Boer
Marieke J
MJ
van Druenen
Dick
D
Tibboel
Hugo J
HJ
Duivenvoorden
D001794:Blood Pressure; D002395:Catecholamines / Q000097:blood; D005149:Facial Expression; D005260:Female; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009020:Morphine / Q000097:blood; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain; D011182:Postoperative Care; D011446:Prospective Studies; D011581:Psychological Tests; D015203:Reproducibility of Results; D014743:Videotape Recording
D002395:Catecholamines; D009020:Morphine