title: Disagreement between parents and health professionals regarding pain intensity in critically ill neonates.
abstract: OBJECTIVE
  To verify whether parents and health professionals homogeneously evaluate presence and intensity of neonatal pain.
  
  
  METHODS
  This cross-sectional study enrolled 52 neonates and 154 adults. Inclusion criteria for neonates were admission to neonatal intensive care unit, presence of gastric tube, tracheal tube, and venous lines. Each newborn was observed by a different group of three adults (parent, nurse assistant and pediatrician) for 1 minute at the same time to evaluate presence and intensity of infant's pain. Homogeneity of pain evaluation was analyzed by a modified Bland-Altman plot and by intraclass correlation coefficient (ICC). Multiple linear regression analysis was used to evaluate association of neonatal characteristics and heterogeneity of pain scores for adults.
  
  
  RESULTS
  ICC showed disagreement of the pain scores given by the three groups of adults (ICC 0.066, agreement > 0.75). Bland-Altman analysis showed agreement among adults when they thought pain was absent. When they thought pain was present, there was heterogeneity of opinions regarding intensity of neonatal pain. Multiple regression analysis indicated that 10% of this disagreement could be explained by infant's gender and mode of delivery.
  
  
  CONCLUSIONS
  Disagreement among adults about intensity of neonatal pain is a marker of the difficulty in deciding the need for analgesia in preverbal patients.
authors.affiliation: Divisão de Pediatria Neonatal, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil.
authors.forename: Luciana S D T
authors.initials: LS
authors.lastname: Elias
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
authors.forename: Clóvis A
authors.initials: CA
authors.lastname: Peres
authors.forename: Rita C X
authors.initials: RC
authors.lastname: Balda
authors.forename: Amelia M N dos
authors.initials: AM
authors.lastname: Santos
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D034462:Dissent and Disputes; D005260:Female; D020445:Hospitalists; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007407:Interviews as Topic; D008297:Male; D009728:Nursing Assistants; D015588:Observer Variation; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000706:statistics & numerical data*; D010290:Parents; D012044:Regression Analysis; D012959:Socioeconomic Factors