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Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale
Daniele Fagioli1, Costanza Evangelista2, Orsola Gawronski3
1Clinical pharmacy unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
The Italian COMFORT Behaviour Scale (CBS) effectively measures pain and distress in paediatric intensive care unit patients. This validated tool ensures accurate pain assessment for better sedation management.
Area of Science:
- Pediatric critical care medicine
- Pain assessment and management
- Psychometrics and scale validation
Background:
- Accurate pain assessment in pediatric intensive care units (PICUs) is vital for preventing risks associated with inadequate sedation.
- The COMFORT Behaviour Scale (CBS) is a key tool for evaluating pain and distress in pediatric patients.
Purpose of the Study:
- To translate and validate the Italian version of the COMFORT Behaviour Scale (CBS).
- To assess the psychometric properties, construct validity, feasibility, and reproducibility of the Italian CBS in a PICU setting.
Main Methods:
- Conducted 71 observations on 35 sedated, mechanically ventilated patients across three PICUs.
- Assessed pain and distress using the Italian CBS and the Nurse Interpretation of Sedation Score (NISS) before and after tracheal suctioning.
Main Results:
- High interrater agreement and reliability were observed before the procedure (100%, Cohen's kappa = 1), with moderate agreement after (79%, Cohen's kappa = 0.558).
- The Italian CBS demonstrated strong internal consistency (Cronbach's alpha = 0.81 and 0.91).
- Low agreement was found between the CBS and NISS (20% and 28%), attributed to NISS's lower precision and potential cultural biases.
Conclusions:
- The Italian version of the CBS is a valid and reproducible tool for objectively measuring pain and distress in diverse pediatric intensive care patients.
- The findings support the use of the Italian CBS for improving pain management in PICUs.
Background:
Assessment of pain in paediatric intensive care units (PICUs) is crucial to minimise the risks of inadequate sedation.
Aim:
To translate and validate the Italian version of the COMFORT behaviour scale (CBS) in a PICU in terms of its psychometric, construct, feasibility and reproducibility properties.
Method:
Before and after tracheal suctioning, 71 observations were performed on 35 sedated and mechanically ventilated patients in three PICUs. Pain and distress were assessed using the CBS and the Nurse Interpretation of Sedation Score (NISS).
Results:
Interrater agreement and interrater reliability were high before the procedure and moderate after (pre: 100%, Cohen's kappa = 1; post: 79%, Cohen's kappa = 0.558). The scale's internal consistency was calculated before and after the procedure (Cronbach's alpha = 0.81 and 0.91). Agreement between the CBS and the NISS was low before and after the procedure (20% and 28%). The agreement between the tools was low because the NISS, a tool based on expert opinion, is not as precise as the CBS and could be affected by cultural biases.
Conclusion:
The Italian version of the CBS proved to be valid and reproducible for the objective measurement of pain and distress in a wide age range of patients admitted to PICUs.
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