The clinimetric properties of the COMFORT scale: A systematic review

Abstract

The COMFORT scale is a measurement tool to assess distress, sedation and pain in nonverbal paediatric patients. Several studies have described the COMFORT scale, but no formal assessment of the methodological quality has been undertaken. Therefore, we performed a systematic review to study the clinimetric properties of the (modified) COMFORT scale in children up to 18 years. We searched Central, CINAHL, Embase, Medline, PsycInfo and Web of Science until December 2014. The selection, data extraction and quality assessment were performed independently by two reviewers. Quality of the included studies was appraised using the COSMIN checklist. We found 30 studies that met the inclusion criteria. Most participants were ventilated children up to 4 years without neurological disorders. The results on internal consistency and interrater reliability showed values of >0.70 in most studies, indicating an adequate reliability. Construct validity resulted in correlations between 0.68 and 0.84 for distress, between 0.42 and 0.94 for sedation and between 0.31 and 0.96 for pain. The responsiveness of the (modified) COMFORT scale seems to be adequate. The quality of the included studies ranged from poor to excellent. The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain. The included studies were clinically and methodologically heterogeneous, hampering firm conclusions. What does this review add?:• An in-depth assessment of the clinimetric properties of the COMFORT scale.• The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain.

Assessment of the Degree of Stress during Pediatric Ground Transport

“…Specific scales for this purpose that can be applied to all ages or noncollaborating children were very scarce. The Comfort scale was appropriate, with excellent results in the validation studies [5]. We also saw that making a small change in the Comfort scale, this could serve us for the objectives of our work.…”

Considerations for pediatric burn sedation and analgesia

“…Distress is defined as “an organism’s response to aversive internal and external stimuli” [ 8 ]. Anxiety is a response based on worry or apprehension, which may be linked to a perceived or real threat.…”

“…Fear and anxiety may be difficult for medical providers to distinguish from pain, particularly in younger children [ 7 ]. Distress and pain are difficult to discriminate, as these experiences may occur simultaneously, influence each other, and present with comparable responses [ 8 ]. Burn pain, specifically, is one of the most severe forms of acute pain [ 10 ].…”

Interventional cohort study of prolonged use (>72 hours) of paracetamol in neonates: protocol of the PARASHUTE study

“…All Danish NICUs use the COMFORT neo pain score for evaluation of pain in neonates. The COMFORT neo pain score has been used for preterm and term neonates for prolonged and acute pain 29–31…”