PT  - JOURNAL ARTICLE
AU  - Ffion James
AU  - Rosie Edwards
AU  - Nirmal James
AU  - Rhian Dyer
AU  - Victoria Goodwin
TI  - The Royal College of Emergency Medicine composite pain scale for children: level of inter-rater agreement
AID  - 10.1136/emermed-2015-205517
DP  - 2017 Jun 01
TA  - Emergency Medicine Journal
PG  - 360--363
VI  - 34
IP  - 6
4099  - http://emj.bmj.com/content/34/6/360.short
4100  - http://emj.bmj.com/content/34/6/360.full
SO  - Emerg Med J2017 Jun 01; 34
AB  - 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.