@article {8294, title = {Nationwide study of headache pain in Italy shows that pain assessment is still inadequate in paediatric emergency care.}, journal = {Acta Paediatr}, volume = {105}, year = {2016}, month = {2016 May}, pages = {e200-8}, abstract = {

AIM: Italian national guidelines on pain management were published in 2010, but there is little information on how effective pain management is in paediatric emergency care, with other countries reporting poor levels. Using headache as an indicator, we described pain assessment in Italian emergency departments and identified predictors of algometric scale use.

METHODS: All Italian paediatric and maternal and child hospitals participated, plus four general hospitals. Data on all children aged 4-14 years admitted during a one-month period with headache as their chief complaint were abstracted from clinical records. Multivariable analyses identified predictors of algometric assessment, taking into account the cluster study design.

RESULTS: We studied 470 admissions. During triage, pain was assessed using a standardised scale (41.5\%), informally (15.5\%) or was not recorded (42.9\%). Only 32.1\% of the children received analgesia in the emergency department. The odds ratios for predictors of algometric assessment were non-Italian nationality (3.6), prehospital medication (1.8), admission to a research hospital (7.3) and a more favourable nurses-to-admissions ratio of 10.8 for the highest versus lowest tertile.

CONCLUSION: Despite national guidelines, paediatric pain assessment in Italian emergency care was suboptimal. Hospital variables appeared to be stronger predictors of adequate assessment than patient characteristics.

}, issn = {1651-2227}, doi = {10.1111/apa.13335}, author = {Benini, Franca and Piga, Simone and Zangardi, Tiziana and Messi, Gianni and Tomasello, Caterina and Pirozzi, Nicola and Cuttini, Marina} } @article {1893, title = {Cognitive assessment of very preterm infants at 2-year corrected age: performance of the Italian version of the PARCA-R parent questionnaire.}, journal = {Early Hum Dev}, volume = {88}, year = {2012}, month = {2012 Mar}, pages = {159-63}, abstract = {

BACKGROUND: Serial assessments of cognitive and language development are recommended for very preterm children, but standardized neuropsychological testing is time-consuming and expensive, as well as tiring for the child.

AIMS: To validate the Italian version of the PARCA-R parent questionnaire and test its clinical effectiveness in assessing cognitive development of very preterm children at 2 years of corrected age.

METHODS: 120 consecutive Italian very preterm children (mean gestational age 28.8 weeks, standard deviation 2.1) were assessed in four hospitals through the Mental Development Index (MDI) of the Bayley Scales of Infant Development (BSID-II). Parents completed the PARCA-R questionnaire, designed to measure children{\textquoteright}s non-verbal and verbal (vocabulary and sentence complexity) cognitive level. The correlation between the MDI and the PARCA-R Parent Report Composite (PRC) was tested through the Pearson correlation coefficient, and the receiver operating characteristic (ROC) curve was used to identify optimal PRC cut-offs.

RESULTS: Significant correlation between the PRC score and MDI (r=0.60, p<0.001) indicated good concurrent validity. The area under the ROC curve was 0.83, and the cut-off of 46 lead to 72.7\% sensitivity and 77.1\% specificity in identifying children with moderate/severe cognitive delay (MDI<70). Negative predictive value was 96.6 (90.3-99.3). Screening through PARCA-R would reduce the number of children with MDI>=70 undergoing BSID-II or equivalent standardized tool from 109 to 25.

CONCLUSIONS: The Italian version of PARCA-R retains good discriminative power for identifying cognitive delay in 2-year very preterm children. It is well accepted by parents, and represents a valid and efficient alternative for developmental screening and outcome measurement.

}, keywords = {Cognition, Female, Humans, Infant, Infant, Newborn, Infant, Premature, Italy, Male, Parents, Questionnaires, ROC Curve}, issn = {1872-6232}, doi = {10.1016/j.earlhumdev.2011.07.022}, author = {Cuttini, Marina and Ferrante, Pierpaolo and Mirante, Nadia and Chiandotto, Valeria and Fertz, Mariacristina and Dall{\textquoteright}Oglio, Anna Maria and Coletti, Maria Franca and Johnson, Samantha} }