The COMFORT behavior scale: Is a shorter observation period feasible?

Objective: The COMFORT behavior scale has been validated for postoperative pain in 0- to 3-yr-old children. Scoring is preceded by a 2-min observation period, which nurses may consider too long. The objective of this study was to test the reliability of a 30-sec observation period. Design: Observational study. Setting: One Level III intensive care unit at a university children’s hospital. Participants: Designated pain specialist and all nursing staff. Interventions: None. Measurements: The pain specialist and caregiver nurse each conducted a bedside COMFORT behavior scale assessment and assigned an additional pain rating on the 11-point Numerical Rating Scale. Main Results: Total COMFORT behavior Scale score for the 2-min observation was 17 or higher in 19% of the patients and 11% for the 30-sec observation. The mean COMFORT behavior scale score for the 2-min observation was 13.5 (SD 3.8) and 12.7 (SD 3.7) for the 30-sec observation. The mean difference therefore was 0.8 (confidence interval 0.6–1.1, paired t test, p < .001). Sensitivity and positive predictive value for the 30-sec observa- tion were 0.44 and 0.80, respectively. Conclusions: A 30-sec COMFORT behavior scale observation increases the risk of underscoring pain. Therefore, the 2-min observation period should be adhered to in the interest of the patients.