 CLINICAL INVESTIGATIONS Anesthesiology 2002; 96:528 –35 © 2002 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Validation of the Non-communicating Children’s Pain Checklist–Postoperative Version Lynn M. Breau, B.A.(Hons.), G. Allen Finley, M.D., F.R.C.P.C.,† Patrick J. McGrath, Ph.D.,‡ Carol S. Camfield, M.D., F.R.C.P.C.§ Background: This study evaluated the psychometric proper- ties of the Non-communicating Children’s Pain Checklist–Post- operative Version (NCCPC-PV) when used with children with severe intellectual disabilities. Methods: The caregivers of 24 children with severe intellec- tual disabilities (aged 3–19 yr) took part. Each child was ob- served by one of their caregivers and one of the researchers for 10 min before and after surgery. They independently completed the NCCPC-PV and made a visual analog scale rating of the child’s pain intensity for those times. A nurse also completed a visual analog scale for the same observations. Results: The NCCPC-PV was internally reliable (Cronbach   0.91) and showed good interrater reliability. A repeated-mea- sures analysis of variance indicated NCCPC-PV total and sub- scale scores were significantly higher after surgery and did not differ by observer. Postoperative NCCPC-PV scores correlated with visual analog scale ratings provided by caregivers and researchers, but not with those of nurses. A score of 11 on the NCCPC-PV, by caregivers, provided 0.88 sensitivity and 0.81 specificity for classifying children with moderate to severe pain. Conclusions: The NCCPC-PV displayed good psychometric properties when used for the postoperative pain of children with severe intellectual disabilities and has the potential to be useful in a clinical setting. The results suggest familiarity with an individual child with intellectual disabilities is not necessary for pain assessment. DESPITE increasing research into pediatric pain in re- cent years, 1 many children are still not appropriately medicated for postoperative pain. In 1983, Mather and Mackie 2 reported 31% of their sample were not given any analgesic postoperatively. The same rate was re- ported by Kart et al. 3 in 1996. A recent study found 51% of 48 children did not receive sufficient postoperative analgesics to keep their pain levels below their personal treatment threshold. 4 One reason for continued inadequate management of postoperative pain could be the lack of available and validated pain assessment tools. Structured pain assess- ment can contribute to improved prescription and ad- ministration of analgesia for children. 5 However, obser- vational postoperative pain tools are still needed for some groups of children, such as those who cannot give self-reports. For example, pain assessment tools for pre- school children have only recently appeared (e.g., FLACC 6 ; Pain Observation Scale for Young Children 7 ; COMFORT 8 ). Children with neurologic impairments are often un- able to report on their pain because of their intellectual or physical limitations. However, at present, no tools have been validated for their postoperative pain. The one study that investigated use of pain tools designed for “normal” children suggests these tools may not be ade- quate for these special children. 9 Thus, pain tools spe- cifically designed for children with intellectual disabili- ties are needed. This study investigated whether the Non-communicat- ing Children’s Pain Checklist (NCCPC), 10 designed spe- cifically for children with intellectual disabilities, could detect their postoperative pain. Previous research sug- gests the NCCPC is valid and reliable in the home set- ting 11 and that caregivers’ report using the NCCPC can predict future pain behavior. 12 However, pain at home may differ from postoperative pain. Thus, validation of the NCCPC for postoperative pain is needed. This should include assessment of its validity and reliability when used by adults who are not familiar with the children having pain to ensure it is clinically useful. To accom- plish these goals, caregivers, researchers, and nurses observed 25 children undergoing surgery at a tertiary care children’s health center. Caregivers were asked to take part in this study because their pain estimates are most closely related to children’s self-reports, 13 and it was felt an examination of the correlation between their ratings, and those of researchers with a different per- spective and no familiarity with the children, would be a stringent test of interrater reliability. This article is accompanied by an Editorial View. Please see: Kain ZN, Cicchetti DV, McClain BC: Measurement of pain in children: State-of-the-art considerations. ANESTHESIOLOGY 2002; 96:523– 6.  * Ph.D. Candidate in Clinical Psychology, Department of Psychology, Dalhou- sie University and Pediatric Pain Research Laboratory. † Professor, Departments of Anesthesia and Psychology, Dalhousie University, and Anesthesiologist and Director, Pediatric Pain Service, IWK Health Centre. ‡ Professor, Departments of Psychology, Pediatrics, Psychiatry, and Biomedical Engineering, Dalhousie University, and Psychologist, Pediatric Pain Service, IWK Health Centre. § Professor, Departments of Pediatrics and Psychology, Dalhousie University, and Pediatrician, Divi- sion of Child Neurology, IWK Health Centre. Received from the IWK Health Centre, Halifax, Nova Scotia, Canada. Submitted for publication February 8, 2001. Accepted for publication October 25, 2001. Supported by The Hospital for Sick Children Foundation, Toronto, Ontario, Canada, and by a Doctoral Fellowship (to Dr. Breau) and a Distinguished Scientist Award (to Dr. McGrath) by the Canadian Institutes of Health Research, Ottawa, Ontario, Canada. Address reprint requests to Ms. Breau: Pediatric Pain Research Laboratory, IWK Health Centre, 5850 University Avenue, Halifax, Nova Scotia, Canada, B3J 3G9. Address electronic mail to: lbreau@ns.sympatico.ca. Individual article re- prints may be purchased through the Journal Web site, www.anesthesiology.org. Anesthesiology, V 96, No 3, Mar 2002 528 Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/96/3/528/404901/0000542-200203000-00004.pdf by guest on 15 November 2021