Agreement of Pain Assessment Using the Short Form of the Canine Glasgow Composite Measure Pain Scale between Veterinary Students, Veterinary Nurses, Veterinary Surgeons, and ECVAA-Diplomates

Abstract

Several pain scoring systems have been validated to measure pain in dogs. However, pain may not be adequately assessed since these tools are associated with high-level inter-observer variation. The aim of this study is to evaluate the agreement of pain assessment using the CMPS-SF between veterinary students, veterinary nurses, veterinary surgeons, and European College of Veterinary Anaesthesia and Analgesia (ECVAA) diplomates. Forty-five client-owned dogs presented to a teaching hospital were enrolled in this prospective, observational study. All dogs were pain-scored in vivo, while a video of the assessment was recorded and subsequently evaluated by twenty assessors, with five per group. Mean scores between groups were compared, and agreement within groups and agreement of the average scores between groups were assessed by calculating the intraclass correlation coefficient (ICC). The intervention point at which dogs were deemed to require additional analgesia was also evaluated. Overall agreement of pain assessment was poor (ICC = 0.494). Nurses had the best inter-observer agreement (ICC = 0.656), followed by ECVAA diplomates (ICC = 0.540), veterinary surgeons (ICC = 0.478), and veterinary students (ICC = 0.432). The best inter-group agreement was between veterinary surgeons and nurses (ICC = 0.951) and between ECVAA diplomates and nurses (ICC = 0.951). Students were more likely to determine that additional analgesia was required compared to other groups. Pain assessment is key for animal welfare, and training in this area should be reinforced to improve consistency.

Keywords: CMPS-SF; agreement; dogs; pain; veterinary students.

Figure 1

Short form (CMPS-SF) of the Glasgow Composite Measure Pain Scale by [10].

Figure 2

Box and whisker plot summarising all pain scores for each of the groups: ECVAA diplomates (ECVAA Dips), registered veterinary nurses (RVNs), fifth-year veterinary students (VUs), and veterinary surgeons (VSs). Boxes represent the interquartile range from the 25th and 75th percentile. The horizontal bar in each box represents the median value for all scores. The whiskers indicate the range of data values unless outliers are present, in which case the whisker extend to a maximum of 1.5 the interquartile range. Such outlying data points are represented by dots.