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Meta-Analysis
. 2022 May;26(5):965-979.
doi: 10.1002/ejp.1936. Epub 2022 Mar 17.

Detection and assessment of postoperative pain in children with cognitive impairment: A systematic literature review and meta-analysis

Anna Pizzinato  1 , Ilaria Liguoro  2 , Anna Pusiol  2 , Paola Cogo  2 , Alvisa Palese  1 , Enrico Vidal  2
Affiliations
Meta-Analysis

Detection and assessment of postoperative pain in children with cognitive impairment: A systematic literature review and meta-analysis

Anna Pizzinato et al. Eur J Pain. 2022 May.

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 (I2 = 97%) and 0.87 (0.84-0.90) for the FLACC scale, with a discrete I2 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.

Significance: This review is focused on the assessment of pain in children with CI in the postoperative period. Simplified observation-based pain assessment tools that rely on evaluating non-verbal expressions of pain should be recommended for children with difficulties to communicate their feelings. Even if there is a high degree of heterogeneity in clinical presentations among youth with CI, two tools (NCCPC-PV and FLACC) have emerged as reliable and valid in this population.

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Conflict of interest statement

All authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) 2020 flow diagram of the included studies on pain assessment scales in children with cognitive impairment (CI). Adapted from Page et al. (2021). For more information, visit: http://www.prisma‐statement.org/
FIGURE 2
FIGURE 2
Interclass correlation coefficient (ICC) of the included studies. Non‐Communicating Children's Pain Checklist‐Postoperative Version (NCCPC‐PV); revised version of the Face, Legs, Activity, Cry, Consolability scale (r‐FLACC); heterogeneity index (I 2).
FIGURE 3
FIGURE 3
Difference in pain assessment's scores between caregivers and external observers among the included studies for the Non‐Communicating Children's Pain Checklist‐Postoperative Version (NCCPC‐PV). CI, Confidence Interval; IV, Inverse Variance; SD, Standard Deviation.
FIGURE 4
FIGURE 4
Difference in pain assessment's scores between caregivers and external observers among the included studies for the revised version of the Face, Legs, Activity, Cry, Consolability scale (r‐FLACC). CI, Confidence Interval; IV, Inverse Variance; SD, Standard Deviation.
See this image and copyright information in PMC

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