Development and validation of the pediatric nausea assessment tool for use in children receiving antineoplastic agents

Study Objective. To develop and validate. an instrument to assess nausea intensity in children aged 4-18 years. Design. Prospective, descriptive study. Setting. Tertiary-quaternary, university-affiliated pediatric hospital. Patients. Four pediatric inpatient groups (177 patients): group 1 (107), those receiving cancer chemotherapy; group 2 (24), those receiving cancer chemotherapy before hematopoietic stem cell transplantation; group 3 (23), those with cancer who were not receiving cancer chemotherapy; and group 4 (23), those without cancer. Intervention. We developed a scale with a standard script for administration, the Pediatric Nausea Assessment Tool (PeNAT). Revisions were made after face validity testing with clinicians and parents, and pilot testing with 15 inpatients undergoing chemotherapy. Measurements and Main Results. The PeNAT scores were obtained 4-24 hours after chemotherapy in groups 1 and 2. Dietary intake scores and number of emetic episodes were recorded for the 4 hours before PeNAT administration for all patients in group 2 and 36 patients in group 1. Parents of a subset of patients made an independent assessment of their child's nausea and pain intensities immediately before PeNAT administration. Reliability was evaluated in groups I and 2 by correlating the first and second (obtained 1 hr after the first) PeNAT scores. Construct validity was evaluated by comparing PeNAT scores in groups 1-4. Criterion-related validity was evaluated by correlating PeNAT scores with emetic episodes and dietary intake. Convergent and discriminant validity were evaluated by correlating PeNAT scores with parental assessments of nausea and pain. Significant differences in PeNAT scores were noted among the study groups (p=0.035). Moderate correlation was noted between the first and second PeNAT scores (Spearman p = 0.649). The PeNAT scores correlated modestly with emetic episodes (Spearman p = 0.322) but not with dietary intake (Spearman p = -0.217). Children's PeNAT scores correlated moderately with their parents' assessment of nausea (Spearman rho = 0.442), whereas little correlation was seen between children's PeNAT scores and parents' assessment of pain (Spearman p = 0. 167). Conclusion. The PeNAT is a new instrument that can be used by children to assess nausea intensity.