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.