title: Taking up the challenge of measuring prolonged pain in (premature) neonates: the COMFORTneo scale seems promising.
abstract: OBJECTIVE
  Pain assessment is essential to tailor intensive care of neonates. The present focus is on acute procedural pain; assessment of pain of longer duration remains a challenge. We therefore tested a modified version of the COMFORT-behavior scale-named COMFORTneo-for its psychometric qualities in the Neonatal Intensive Care Unit setting.
  
  
  METHODS
  In a clinical observational study, nurses assessed patients with COMFORTneo and Numeric Rating Scales (NRS) for pain and distress, respectively. Interrater reliability, concurrent validity, and sensitivity to change were calculated as well as sensitivity and specificity for different cut-off scores for subsets of patients.
  
  
  RESULTS
  Interrater reliability was good: median linearly weighted Cohen kappa 0.79. Almost 3600 triple ratings were obtained for 286 neonates. Internal consistency was good (Cronbach alpha 0.84 and 0.88). Concurrent validity was demonstrated by adequate and good correlations, respectively, with NRS-pain and NRS-distress: r=0.52 (95% confidence interval 0.44-0.59) and r=0.70 (95% confidence interval 0.64-0.75). COMFORTneo cut-off scores of 14 or higher (score range is 6 to 30) had good sensitivity and specificity (0.81 and 0.90, respectively) using NRS-pain or NRS-distress scores of 4 or higher as criterion.
  
  
  CONCLUSIONS
  The COMFORTneo showed preliminary reliability. No major differences were found in cut-off values for low birth weight, small for gestational age, neurologic impairment risk levels, or sex. Multicenter studies should focus on establishing concurrent validity with other instruments in a patient group with a high probability of ongoing pain.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Room Sk 1276, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. m.vandijk.3@erasmusmc.nl
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.forename: Daniella W E
authors.initials: DW
authors.lastname: Roofthooft
authors.forename: Kanwaljeet J S
authors.initials: KJ
authors.lastname: Anand
authors.forename: Fleur
authors.initials: F
authors.lastname: Guldemond
authors.forename: Joke
authors.initials: J
authors.lastname: de Graaf
authors.forename: Sinno
authors.initials: S
authors.lastname: Simons
authors.forename: Youette
authors.initials: Y
authors.lastname: de Jager
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D019370:Observation / Q000379:methods; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy; D010147:Pain Measurement / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014894:Weights and Measures
chemical_list: D000700:Analgesics