2026 FSA Podium and Poster Abstracts

Background: Children with cognitive impairment (CI) frequently undergo surgical and critical care interventions yet remain vulnerable to undertreated pain due to inability to self-report. The Non-Communicating Children’s Pain Checklist (NCCPC) is one of the most widely studied behavioral pain assessment tools for this population. Although individual validation studies report strong psychometric performance, the clinical contexts in which these validations were conducted may not reflect high-acuity perioperative and critical care environments.

Objective: To systematically review and map validation evidence for all NCCPC versions across clinical settings, pain contexts, and patient characteristics, with particular focus on identifying gaps relevant to perioperative and critical care applications.

Methods: A systematic review was conducted using PubMed, EMBASE, and Cochrane databases (inception–January 2026) to identify studies reporting original psychometric validation of any NCCPC version (NCCPC, NCCPC-R, NCCPC-PV, and translated/adapted forms). Studies were categorized across predefined domains: clinical setting (home/community, outpatient, inpatient ward, PACU, PICU), pain context (postoperative, procedural, chronic/everyday), patient characteristics (etiology of CI, ventilation status, sedation exposure), and psychometric outcomes (internal consistency, inter-rater reliability, diagnostic accuracy). Validation contexts were systematically mapped against common perioperative and critical care scenarios.

Results: Twenty-three validation studies met inclusion criteria. Validation was conducted primarily in home, community, and general inpatient ward settings, with limited representation of acute perioperative or critical care environments. No studies specifically evaluated NCCPC use in PICU populations, mechanically ventilated patients, sedated patients, or procedural pain contexts. Across studied settings, NCCPC instruments demonstrated strong internal consistency and inter-rater reliability. However, reporting of patient characteristics, ventilation status, sedation exposure, and observer training varied across studies, limiting assessment of generalizability to high-acuity clinical settings.

Conclusions: Although NCCPC instruments demonstrate robust psychometric performance in low- and moderate-acuity settings, current validation evidence does not extend to high-acuity perioperative and critical care contexts frequently encountered in pediatric anesthesia. This systematic evidence mapping identifies critical gaps in validation among mechanically ventilated, sedated, and procedurally treated populations and highlights priority areas for targeted future research.