The measurement properties of pediatric observational pain scales: A systematic review of reviews
Section snippets
What is already known about the topic?
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The implementation and use of structured pain scales are considered the foundation for effective management of pain
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Children that lack the verbal or cognitive ability to self-report pain are at increased risk for suffering untreated pain and a large number of observational scales to assess pain in these children have been published over the last 30 years
What this paper adds
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There is no clear consensus regarding which scales to use; although the Face, Legs, Activity, Cry, Consolability/revised version of Face, Legs, Activity, Cry, Consolability, COMFORT/COMFORT behavioral scale and Children’s Hospital of Eastern Ontario Pain Scale were recommended most frequently, 28 of the 65 evaluated scales were recommended at least once
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These recommendations should be interpreted with caution due to the high or uncertain risk of bias and corresponding low evidence in the reviews
Design
This systematic review was conducted according to PRISMA guidelines (Liberati et al., 2009) and the review protocol has been registered with PROSPERO, registration number CRD42016035264.
Data sources and search strategy
The Cochrane Library, PubMed/MEDLINE, CINAHL, Web of Science, and PsychINFO were searched from inception to November 2015 and the search updated last in September 2016. No language or time limitations were applied. Search terms described the population (children from birth to 18 years of age), type of study
Identification and selection of reviews
All articles identified through database and complementary searches (n = 1739) were imported to EndNote. After duplicates (n = 105) were removed, 1532 articles were excluded based on title and abstract, and 102 full texts were retrieved and screened. Following the predefined eligibility criteria, 13 full texts describing 12 systematic reviews (Bai and Jiang, 2015, Bennett et al., 2009, Crellin et al., 2007, Crellin et al., 2015, Dorfman et al., 2014, Duhn and Medves, 2004, Ely et al., 2012,
Discussion
Together, the 12 reviews evaluated 65 different observational pain scales and 28 of these were recommended at least once. The FLACC/rFLACC, COMFORT/COMFORT behavioral scale and CHEOPS were recommended most frequently. Few of these reviews assessed the methodological quality of the included studies. None attempted a meta-analysis of data regarding measurement properties, and the narrative analysis was limited and consisted mostly of a reiteration of the results of the studies included in them.
Conclusions
The recommendations regarding observational pain scales for use in clinical practice or research with children vary widely across published reviews, have low evidence, and should be interpreted with caution.
There may be several reasons for these disappointing results. One is the state of the science, including the lack of a common terminology and understanding of measurement properties; few published methods to assess the methodological quality of validation studies and measurement properties
Conflicts of interest
None declared.
Acknowledgements
The authors would like to express their gratitude to the clinical health librarians at the university library of the Karolinska Institutet for their help in developing the search strategy, and to Liana Albuquerque da Silva and Ana Claudia Vieira for help in screening articles written in Portuguese. RDA is a trainee member of Pain in Child Health (PICH), a strategic research training initiative of the Canadian Institutes of Health Research.
This research did not receive any specific grant from
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