A203 PEDIATRIC VALIDATION OF THE NURSE-ASSESSED PATIENT COMFORT SCORE (NAPCOMS) IN CHILDREN UNDERGOING COLONOSCOPY
Bibliographic record
Abstract
Given the subjective nature of pain, it is difficult to assess the level of pain and discomfort felt by patients during medical procedures. Several tools have been developed in order to objectively evaluate the level of pain, such as the Nurse-Assessed Patient Comfort Score (NAPCOMS). This scale was designed and prospectively validated in a cohort of 300 adults undergoing colonoscopy (Rostom et al). It includes three domains: a) pain (intensity- frequency-duration), the sum of the three items gives a total pain score between 0 and 9 (0 being no pain, and 9 the highest level); b) sedation level (0–3); and c) a global tolerability rating (0–3). In children, no reliable tool exists to assess pain and comfort during colonoscopy. As part of our quality assurance program in pediatric digestive endoscopy, sedation, pain and comfort were considered as main quality indicators. We conducted this study to validate the NAPCOMS in a pediatric setting with patients undergoing colonoscopy under intravenous (IV) sedation. NAPCOMS validation was carried out in two steps. In the first step, two research assistants simultaneously and independently recorded the NAPCOMS during endoscopic procedures in the operating room (N=34 patients). The results were compared using the Spearman correlation. For the second analysis, a research assistant and an endoscopy nurse completed the score (N=33 patients). The results of the research assistant and the endoscopy nurse were compared with the Spearman correlation. One hour after the procedure, patients reported two different outcomes: a global evaluation of procedural pain (Yes/No) and a comfort assessment on a 3-point Likert (no discomfort, mild discomfort severe discomfort). For the first step, the intraclass correlation was 0.90 between the two research assistants for the pain score (p<0.0010). As for the second step, the intraclass correlation was 0.94 between the nurse and the research assistant for the pain score (p<0.0010). There was a modest correlation between the NAPCOMS and pain perception as expressed by the patients partly due to a high percentage of children expressing amnesia of procedure (20%). The Spearman correlation between NAPCOMS and patients experience of pain and comfort were 0.42 (p< 0.002) and 0.031 (p=0.02) respectively. The NAPCOMS can be considered as a reliable pain assessment tool for pediatric colonoscopy. There was a high agreement between the two investigators and the endoscopy nurse. FRQS
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".