{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T06:12:25Z","timestamp":1769753545952,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T00:00:00Z","timestamp":1703289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The Children's and Infant's Postoperative Pain Scale (CHIPPS) and the German version of the Parent's Postoperative Pain Measure (PPPM\u2010D) are used to assess postoperative pain intensity in preschool children. However, they have shown low concordance in previous prospective studies on quality improvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>Our secondary analysis aimed to estimate the association strength between the pain score items and indication for rescue medication defined as CHIPPS \u22654 and\/or PPPD\u2010D\u2009\u2265\u20096. Thus, we intended to create a further developed pain instrument with fewer variables for easier routine use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 1067 pain intensity assessments of hospitalized children for the development of our novel tool in two steps using modern statistical and machine\u2010learning methods: (1) Boruta variable selection to analyze the association strength between CHIPPS score, PPPM\u2010D items, age, weight, and elapsed time after surgery, including their interactions and pattern stability, and the binary outcome (analgesics required yes\/no). (2) Symbolic regression to generate a short formula with the least number of variables and highest accuracy for rescue medication indication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Additional analgesics were required in 19.96% of pain intensity assessments, whereby the PPPM\u2010D showed higher variance than CHIPPS. Boruta identified PPPM\u2010D score, CHIPPS score, 9 of the 15 PPPM\u2010D variables, and time of assessment as associated with the indication for RM. Symbolic regression revealed that additional analgesics are required if CHIPPS is \u22654 OR PPPM\u2010D item \u201cless energy than usual\u201d AND one of the items \u201cmore easily cry\u201d or \u201cmore groan\/moan\u201d are answered with \u201cyes.\u201d These PPPM\u2010D items were not redundant and showed nonlinear course over time. The cross\u2010validated accuracy for this assessment tool was 94.94%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The new instrument is easy to use and may improve postoperative pain intensity assessment in children. However, it requires prospective validation in a new cohort.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14824","type":"journal-article","created":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T08:04:50Z","timestamp":1703318690000},"page":"347-353","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["New postoperative pain instrument for toddlers\u2014Secondary analysis of prospectively collected assessments after tonsil surgery"],"prefix":"10.1111","volume":"34","author":[{"given":"P.","family":"Gude","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Ruhr\u2010University Bochum, St. Josef\u2010 and St.\u00a0Elisabeth\u2010Hospital Bochum  Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Geldermann","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Ruhr\u2010University Bochum, St. Josef\u2010 and St.\u00a0Elisabeth\u2010Hospital Bochum  Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Gustedt","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Ruhr\u2010University Bochum, St. Josef\u2010 and St.\u00a0Elisabeth\u2010Hospital Bochum  Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Grobe","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Ruhr\u2010University Bochum, St. Josef\u2010 and St.\u00a0Elisabeth\u2010Hospital Bochum  Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. 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I.","family":"Georgevici","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Ruhr\u2010University Bochum, St. Josef\u2010 and St.\u00a0Elisabeth\u2010Hospital Bochum  Bochum Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,23]]},"reference":[{"issue":"3","key":"e_1_2_9_2_1","first-page":"293","article-title":"The FLACC: a behavioral scale for scoring postoperative pain in young children","volume":"23","author":"Merkel SI","year":"1997","journal-title":"Pediatr Nurs"},{"key":"e_1_2_9_3_1","first-page":"395","article-title":"CHEOPS: a behavioral scale for rating postoperative pain in children","volume":"9","author":"McGrath PJ","year":"1985","journal-title":"Adv Pain Res Ther"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198809010-00770"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(92)90031-6"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2000.00530.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2009.05.012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0304-3959(96)03209-5"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002508-199509000-00011"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00482-011-1092-6"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(03)00256-2"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0596-7675"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-020-05929-5"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13959"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i11"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000000819"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14407"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2010.10.002"},{"key":"e_1_2_9_19_1","first-page":"281","volume-title":"Symbolic Regression Analysis. 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