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The Royal College of Emergency Medicine composite pain scale for children: level of inter-rater agreement
  1. Ffion James1,
  2. Rosie Edwards2,
  3. Nirmal James2,
  4. Rhian Dyer3,
  5. Victoria Goodwin4
  1. 1 Faculty of Medicine, Cardiff University, Cardiff, UK
  2. 2 Department of Emergency Medicine, Royal Gwent Hospital, Newport, UK
  3. 3 Department of Emergency Medicine, Princess of Wales Hospital, Bridgend, UK
  4. 4 Department of Emergency Medicine, Prince Charles Hospital, Merthyr Tydfil, UK
  1. Correspondence to Nirmal James, Department of Emergency Medicine, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, UK; Nirmal.James{at}wales.nhs.uk

Abstract

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.

Conclusion The Ladder score could be omitted from this composite tool as it has poor inter-rater agreement in comparison with the other indicators.

  • pain management
  • paediatrics, paediatric emergency medicine

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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