Related Experiment Video
Updated: Jun 2, 2026
A System for Tracking the Dynamics of Social Preference Behavior in Small Rodents
Published on: November 21, 2019
The COMFORT behavior scale: is a shorter observation period feasible?
Anneke A Boerlage1, Erwin Ista, Marjan de Jong
1Intensive Care and Department of Pediatric Surgery, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands. a.boerlage@erasmusmc.nl
Insights
A shorter 30-second observation period for the COMFORT Behavior Scale risks underestimating pain in children. The validated 2-minute observation is crucial for accurate pediatric pain assessment.
Area of Science:
- Pediatric critical care
- Pain management
- Nursing research
Background:
- The COMFORT Behavior Scale (CBS) is validated for assessing postoperative pain in young children (0-3 years).
- Current CBS protocol involves a 2-minute observation period, which may be perceived as lengthy by nursing staff.
- Investigating shorter observation periods is essential for optimizing clinical workflow without compromising patient care.
Purpose of the Study:
- To evaluate the reliability and accuracy of a shortened 30-second observation period for the COMFORT Behavior Scale in pediatric patients.
- To determine if a 30-second observation period adequately captures pain indicators compared to the standard 2-minute period.
Main Methods:
- An observational study was conducted in a university children's hospital intensive care unit.
- A pain specialist and the primary nurse independently assessed pain using the COMFORT Behavior Scale and the Numerical Rating Scale.
- Data were collected for both the standard 2-minute and a proposed 30-second observation periods.
Main Results:
- The 30-second observation period showed a lower incidence of high COMFORT Behavior Scale scores (11%) compared to the 2-minute period (19%).
- Mean COMFORT Behavior Scale scores were slightly lower with the 30-second observation (12.7) versus the 2-minute observation (13.5), with a statistically significant difference (p < .001).
- Sensitivity and positive predictive value for the 30-second observation were 0.44 and 0.80, respectively, indicating potential for missed pain indicators.
Conclusions:
- A 30-second observation period for the COMFORT Behavior Scale increases the risk of underestimating pediatric pain.
- Adherence to the validated 2-minute observation period is recommended to ensure accurate pain assessment in children.
- Shortening the observation period may compromise the reliability of the COMFORT Behavior Scale in clinical practice.
Objective:
The COMFORT behavior scale has been validated for postoperative pain in 0- to 3-yr-old children. Scoring is preceded by a 2-min observation period, which nurses may consider too long. The objective of this study was to test the reliability of a 30-sec observation period.
Design:
Observational study.
Setting:
One Level III intensive care unit at a university children's hospital.
Participants:
Designated pain specialist and all nursing staff.
Interventions:
None.
Measurements:
The pain specialist and caregiver nurse each conducted a bedside COMFORT behavior scale assessment and assigned an additional pain rating on the 11-point Numerical Rating Scale.
Main Results:
Total COMFORT behavior Scale score for the 2-min observation was 17 or higher in 19% of the patients and 11% for the 30-sec observation. The mean COMFORT behavior scale score for the 2-min observation was 13.5 (SD 3.8) and 12.7 (SD 3.7) for the 30-sec observation. The mean difference therefore was 0.8 (confidence interval 0.6-1.1, paired t test, p < .001). Sensitivity and positive predictive value for the 30-sec observation were 0.44 and 0.80, respectively.
Conclusions:
A 30-sec COMFORT behavior scale observation increases the risk of underscoring pain. Therefore, the 2-min observation period should be adhered to in the interest of the patients.
