Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants
T Debillona, V Zupanb, N Ravaulta, J-F Magnyc, M Dehanb
a Neonatal Intensive
Care Unit, Mother-Child University Hospital, Nantes, France, b Neonatal Intensive
Care Unit, Antoine Béclère University Hospital, Clamart, France, c Neonatal
Intensive Care Unit, Infant Care Institute, Paris, France
Correspondence to: Dr Debillon, Service de Réanimation Néonatale, Hôpital Mère-Enfant, Centre Hospitalier Universitaire de Nantes, 44 093 Nantes Cedex 01, France thierry.debillon{at}chu-nantes.fr
Accepted 26 January
2001
OBJECTIVE
To develop
and validate a scale suitable for use in clinical practice as a tool
for assessing prolonged pain in premature infants.
METHODSPain
indicators identified by observation of preterm infants and selected by
a panel of experts were used to develop the EDIN scale (Échelle
Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale). A
cohort of preterm infants was studied prospectively to determine
construct validity, inter-rater reliability, and internal consistency
of the scale.
RESULTSThe EDIN scale
uses five behavioural indicators of prolonged pain: facial activity,
body movements, quality of sleep, quality of contact with nurses, and
consolability. The validation study included 76 preterm infants with a
mean gestational age of 31.5 weeks. Inter-rater reliability was
acceptable, with a 
coefficient range of 0.59-0.74. Internal
consistency was high: Cronbach's 
coefficients calculated after
deleting each item ranged from 0.86 to 0.94. To establish construct
validity, EDIN scores in two extreme situations (pain and no pain) were
compared, and a significant difference was observed.
CONCLUSIONSThe
validation data suggest that the EDIN is appropriate for assessing
prolonged pain in preterm infants. Further studies are warranted to
obtain further evidence of construct validity by comparing scores in
less extreme situations.
Keywords: prolonged pain; pain scale; assessment; validation; premature
© 2001 by Archives of Disease in Childhood
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