title: Development of the paediatric pain profile: role of video analysis and saliva cortisol in validating a tool to assess pain in children with severe neurological disability.
abstract: The Paediatric Pain Profile (PPP) is a 20-item behavior-rating scale designed to assess pain in children with severe to profound neurological impairment. Three raters independently used the PPP to rate behavior of 29 children (mean age 9.6, SD 5.8) filmed during everyday morning activities. The validation process included assessment of interrater reliability and exploration of the relationship of PPP scores with saliva cortisol concentration. There was substantial agreement between raters. The PPP showed strong association with global pain assessments and differentiated between preselected high- and low-pain groups. PPP score showed moderate correlation with saliva cortisol concentration, but a single child explained the strength of the relationship and overall, saliva cortisol concentrations appeared low. The data provide additional evidence that the PPP is a reliable and valid instrument for pain assessment in neurologically impaired children. Cortisol levels are not a useful criterion for pain in this population and further study of cortisol response to stress/pain in children with severe neurological impairments is needed.
authors.affiliation: Department of Nursing, Faculty of Health, University of Central Lancashire, Preston, Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, London, United Kingdom. ahunt@uclan.ac.uk
authors.forename: Anne
authors.initials: A
authors.lastname: Hunt
authors.forename: Alison
authors.initials: A
authors.lastname: Wisbeach
authors.forename: Kate
authors.initials: K
authors.lastname: Seers
authors.forename: Ann
authors.initials: A
authors.lastname: Goldman
authors.forename: Nicola
authors.initials: N
authors.lastname: Crichton
authors.forename: Leslie
authors.initials: L
authors.lastname: Perry
authors.forename: Kiki
authors.initials: K
authors.lastname: Mastroyannopoulou
mesh_terms: D000293:Adolescent; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000378:metabolism* / Q000523:psychology*; D010146:Pain / Q000209:etiology / Q000378:metabolism / Q000523:psychology; D010147:Pain Measurement / Q000379:methods*; D015203:Reproducibility of Results; D012463:Saliva / Q000378:metabolism*; D014743:Videotape Recording
chemical_list: D006854:Hydrocortisone