Measuring distress in South African children during burns dressing changes: A pilot study

Objectives: To establish and trial a practical, evidence-based, sensitive, language-fair, and culture-fair test battery to measure South African children’s distress during burns dressing change. Methods: We previously identified a broad test battery for pediatric procedural distress from the literature. This comprised child and parent heart rate; three instruments for observed distress behaviors—(1) Face, Legs, Activity, Cry, Consolability (FLACC); (2) Pain Behavior Check List (PBCL); and (3) Children’s Hospital Eastern Ontario Pain Scale (CHEOPS); and dressing change time, number of nurses required, and nurses’ perspectives of child’s distress. A consecutive cohort of South African inpatient children with burns was recruited. In the first study, three observers independently piloted the broad set of measures on four children. This set was subsequently modified to increase practicality of application and measurement sensitivity. In the second study, the modified battery was tested on 16 children for sensitivity to different children’s distress levels during burns dressing change phases. Results: The modified test battery was comprised of the CHEOPS, dressing change time, number of nurses required, and nurses’ qualitative perspectives of child’s distress. In combination, these tests were practical and sensitive to children’s distress. Discussion: South African children’s distress during burn dressing changes manifests in different ways. Adequate capture of it requires a comprehensive set of objective, observational, and qualitative measures, which are independent of language and culture.