Assessing pain in ventilated newborns and infants: validation of the Hartwig score

Abstract

The Hartwig score was designed to assess pain in ventilated newborns and infants. It comprises the acceptance of mechanical ventilation and the reaction to endotracheal suctioning (grimacing, gross motor movements, eye-opening). The aim of this study was to validate the Hartwig score in terms of concurrent validity, internal consistency, inter-rater correlation and to define a cut-off value with respect to the need for analgesic therapy. Fifty-four video recordings of 28 ventilated newborns and infants up to 10 months old during endotracheal suctioning were assessed by two neonatologists and two nurses using the Hartwig score, Comfort scale and a visual analogue scale (VAS) in respect to pain. Statistical analysis was done with SPSS 12.0. Comparison of the Hartwig score with the VAS resp. Comfort scale, as according to Bland-Altman, gave a mean of the differences of 0.77 resp. 0.15. A cut-off value of 12.1 to discriminate pain requiring treatment had a sensitivity of 88.9% and a specificity of 100%. Cronbach's alpha of item correlation of the total score was 0.872, deleting the weakest item improved internal consistency to 0.895. Inter-rater correlation was found to be 0.934. Conclusion The Hartwig score showed satisfactory agreement with the VAS and good agreement with the Comfort scale. It is a reliable tool for assessing pain in ventilated newborns and infants. The cut-off value was found to be at 13 points.