The Royal College of Emergency Medicine composite pain scale for children: level of inter-rater agreement.
OBJECTIVE
To assess the inter-rater agreement of the Royal College of Emergency Medicine (RCEM) Composite Pain Scale.


METHODS
A prospective, observational study of 117 children who presented to the ED with pain due to a limb injury. Pain severity was assessed by the triage nurse, doctor and child (depending on their age) using indicators of the RCEM Composite Pain Scale. This pain scale comprises a modified Wong-Baker FACES Pain Rating Scale (FACES Scale), a Behaviour scale and a numerical rating scale (Ladder). Comparisons were made between scores from individual scales and raters.


RESULTS
117 children (26 aged 0-8 years (group 1) and 91 aged >8-16 years (group 2)) were enrolled in the study. Pain in group 1 was assessed by the nurse and doctor using the FACES Scale and the Behaviour scale. The FACES Scale demonstrated greater inter-rater agreement than the Behaviour scale. Pain in group 2 was assessed by the nurse and doctor using the Behaviour scale and by the child using the FACES Scale and Ladder. The Ladder demonstrated poor inter-rater agreement in comparison with the Behaviour Score.


CONCLUSIONS
The Ladder score could be omitted from this composite tool as it has poor inter-rater agreement in comparison with the other indicators.
Faculty of Medicine, Cardiff University, Cardiff, UK.
Ffion
F
James
Department of Emergency Medicine, Royal Gwent Hospital, Newport, UK.
Rosie
R
Edwards
Department of Emergency Medicine, Royal Gwent Hospital, Newport, UK.
Nirmal
N
James
Department of Emergency Medicine, Princess of Wales Hospital, Bridgend, UK.
Rhian
R
Dyer
Department of Emergency Medicine, Prince Charles Hospital, Merthyr Tydfil, UK.
Victoria
V
Goodwin
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004635:Emergency Medicine / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005121:Extremities / Q000293:injuries*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000175:diagnosis; D010147:Pain Measurement / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results
paediatrics, paediatric emergency medicine; pain management