Comparison of “Comfort” Score for Pain Performed by Nursing Staff and Primary Investigator in Paediatric Mechanically Ventilated Patients in a Tertiary Health Care Centre

Abstract

Context: Mechanical ventilation can be traumatic despite administration of sedatives. Sedation can mask uncontrolled pain for intubated patients and prevent them from communicating it. An optimal scoring system for sedation and analgesia can facilitate comparisons. Aims: Compare the COMFORT score performed by the nursing staff on paediatric mechanically ventilated patients to the one performed by the principal investigator. Settings and Design: This Prospective observational study was conducted in a tertiary care hospital. Sixty five patients fulfilling the inclusion criteria were included. Methods and Material: COMFORT scoring was performed by the nursing staff in Paediatric Intensive Care Unit (PICU) on all ventilated patients three times each day. The primary investigator performed the scoring at the same time, but independent of the staff, to enable comparison. Statistical analysis used: Statistical testing has been conducted with the statistical package version SPSS 20.0. For all statistical tests, a p value <0.05 will be taken to indicate a significant difference/association. Results: Our study showed significant difference in assessment of COMFORT score by the investigator and nursing staff. Of our patients, 44.6% were over sedated and 55.4% were optimally sedated. None were under sedated. No correlation was noted between the duration of intubation, age, gender, indication of intubation and type of cases with COMFORT score. However, significant association was found between COMFORT score and outcome of the patient, with lower scores for those who died in comparison to survivors. Conclusions: Presence of dedicated person for pain assessment can lead to more efficient management.