title: A comparison of three scales for measuring pain in children with cognitive impairment.
abstract: OBJECTIVE
  Pain is a neglected problem in children with cognitive impairments, and few studies compare the clinical use of specific pain scales. We compared the Non-Communicating Children's Pain Checklist Postoperative Version (NCCPC-PV), the Echelle Douleur Enfant San Salvador (DESS) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The first two were developed for children with cognitive impairment, and the third is a more general pain scale.
  
  
  METHODS
  Two external observers and the child's caregiver assessed 40 children with cognitive impairment for pain levels. We assessed inter-rater agreement, correlation, dependence on knowledge of the child's behaviour, simplicity and adequacy in pain rating according to the caregiver for all three scales.
  
  
  RESULTS
  The correlation between the NCCPC-PV and the DESS was strong (Spearman correlation coefficient = 0.76) and better than between each scale and the CHEOPS. Although the DESS showed better inter-rater agreement, it was more dependent on familiarity with the child and was judged more difficult to use by all observers. The NCCPC-PV was the easiest use and the most appropriate for rating the child's pain.
  
  
  CONCLUSIONS
  The NCCPC-PV was the easiest to use for pain assessment in cognitively impaired children and should be adopted in clinical settings.
authors.affiliation: University of Trieste, Trieste, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Massaro
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ronfani
authors.affiliation: University of Trieste, Trieste, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Ferrara
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Badina
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Giorgi
authors.affiliation: Department of Physical Medicine and Rehabilitation (Children's Rehabilitation Service), Physical Medicine and Rehabilitation Hospital, Udine, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: D'Osualdo
authors.affiliation: University of Trieste, Trieste, Italy.|Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Taddio
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Barbi
mesh_terms: D000293:Adolescent; D057189:Checklist; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis
keywords: Cerebral palsy; Children; Cognitive impairment; Pain assessment