Detection and assessment of postoperative pain in children with cognitive impairment: A systematic literature review and meta-analysis
Authors:
Pizzinato, A., Liguoro, I., Pusiol, A., Cogo, P., Palese, A., and Vidal, E.
Abstract:
BACKGROUND AND OBJECTIVE: Children with cognitive impairment (CI) are at risk of experiencing pain. Several specific pain rating scales have been developed to date Thus, the aim of this meta-analysis was to estimate the degree of reliability of different pain assessment scales for the postoperative pain in children with CI.
DATABASES AND DATA TREATMENT: PubMed, Scopus and Web of Science databases were approached: all studies validating and/or using pain assessment tool in children (0-20 years) with CI published in English from the 1st of January 2000 to the 1st of January 2022 were included. Only studies reporting the Interclass-Correlation Coefficient (ICC) to evaluate the concordance between caregivers' and external researchers' scores were eligible.
RESULTS: Twelve studies were included (586 children with CI, 60% males; weighted mean age 9.9 years - range 2-20). Five of them evaluated the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV) scale whereas four the original and revised Face, Legs, Activity, Cry, Consolability (FLACC) scale. The analysis showed an overall ICC value of 0.76 (0.74-0.78) for the NCCPC-PV scale, with a high heterogeneity index (I 2 = 97%) and 0.87 (0.84-0.90) for the FLACC scale, with a discrete I 2 index (59%).
CONCLUSIONS: The NCCPC-PV and FLACC pain rating scales showed the strongest evidence for validity and reliability for assessing postoperative pain in children with CI. However, due to the high heterogeneity of the studies available, these results should not be considered conclusive.
Certain conditions originating in the perinatal period and related symptoms Congenital malformations, deformations and chromosomal abnormalities and related symptoms Injury, poisoning and certain other consequences of external causes Mental and behavioural disorders and related symptoms
