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The Validity of Skin Conductance For Assessing Acute Pain in Infants

A Scoping Review

Hu, Jiale RN, MScN*; Modanloo, Shokoufeh RN, MScN*; Squires, Janet E. RN, PhD*,†; Harrold, JoAnn MD, FRCPC‡,§; Harrison, Denise RN, PhD*,∥

doi: 10.1097/AJP.0000000000000721
Review Articles

Objectives: Measuring pain in infants is important but challenging, as there is no “gold standard.” The measurement of skin conductance (SC) is considered to be a measure of stress and as a surrogate indicator of pain. The objectives of this study were to identify the extent of research conducted and to synthesize the validity evidence of SC for assessing acute pain in infants.

Methods: The Arksey and O’Malley framework for scoping reviews was followed, and 9 electronic databases were searched. Data were analyzed thematically and presented descriptively including the following main categories: study information/details, sampling information, characteristics of participants and settings, SC outcome measures, and validity evidence.

Results: Twenty-eight studies with 1061 infants were included, including 23 cross-sectional observation studies and 5 interventional studies. The most studied infants were those with mild severity of illness (n=13) or healthy infants (n=12). The validity evidence of SC was tested in relation to referent pain measures (13 variables), stimuli (13 variables), age (2 variables), and other contextual variables (11 variables). SC was not significantly correlated with vital signs, except for heart rate in 2 of the 8 studies. SC was significantly correlated with the unidimensional behavioral pain assessment scales and crying time rather than with multidimensional measurements. Fourteen of 15 studies (93.3%) showed that SC increased significantly during painful procedures.

Conclusions: Inconsistent findings on validity of SC exist. Future research should aim to identify the diagnostic test accuracy of SC compared with well-accepted referent pain measures in infants, study the validity evidence of SC in critically ill infants, and utilize rigorous research design and transparent reporting.

*School of Nursing

Faculty of Medicine, University of Ottawa

Ottawa Hospital Research Institute

§Children’s Hospital of Eastern Ontario (CHEO) and The Ottawa Hospital

Children’s Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada

This study was funded by the Canadian Pain Society (CPS) Trainee Research Award (Clinical Science, 2018 to 2019), Toronto, Canada, and the Sigma Theta Tau International/Rosemary Berkel Crisp Research Award (2018 to 2019), IN. J.Hu was supported by Ontario Trillium Scholarship (2015 to 2019) and International Doctoral Scholarship, Ottawa, Canada. The authors declare no conflict of interest.

Reprints: Jiale Hu, RN, MScN, University of Ottawa, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1 (e-mail:

Received December 5, 2018

Received in revised form March 5, 2019

Accepted April 17, 2019

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