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Updated: Aug 18, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Cross-validation of a composite pain scale for preschool children within 24 hours of surgery
S Suraseranivongse1, U Santawat, K Kraiprasit
1Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Insights
The Children
Area of Science:
- Pediatric Pain Management
- Clinical Assessment Tools
Background:
- Accurate pain assessment in children is crucial for effective postoperative care.
- Existing pain scales require validation in diverse pediatric populations.
- Cross-validation of multiple pain assessment tools is needed for clinical utility.
Purpose of the Study:
- To cross-validate a composite measure of four pediatric pain scales.
- To assess the validity and reliability of the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), Objective Pain Scale (OPS), Toddler Preschool Postoperative Pain Scale (TPPPS), and FLACC scale in Thai children.
- To evaluate the discriminative validity and agreement with clinical pain treatment decisions.
Main Methods:
- 167 Thai children aged 1-5.5 years undergoing surgery were included.
- Pain scales were translated and tested for content, construct, and concurrent validity.
- Inter-rater and intra-rater reliabilities were assessed using videotaped pain behaviors rated by four observers.
Main Results:
- All scales demonstrated acceptable content validity and excellent inter-rater/intra-rater reliability.
- Construct validity was supported by the ability to differentiate pain levels pre- and post-surgery.
- CHEOPS showed the best agreement with clinical decisions to treat pain.
Conclusions:
- The CHEOPS scale is a valid, reliable, and practical tool for assessing pain in Thai children aged 1-5.5 years.
- CHEOPS demonstrated superior agreement with clinical pain management decisions compared to other scales.
- Further research is needed to optimize pain assessment in different age groups and clinical settings.
Abstract:
This study was designed to cross-validate a composite measure of the pain scales CHEOPS (Children's Hospital of Eastern Ontario Pain Scale), OPS (Objective Pain Scale, simplified for parent use by replacing blood pressure measurement with observation of body language or posture), TPPPS (Toddler Preschool Postoperative Pain Scale) and FLACC (Face, Legs, Activity, Cry, Consolability) in 167 Thai children aged 1-5.5 yr. The pain scales were translated and tested for content, construct and concurrent validity, including inter-rater and intra-rater reliabilities. Discriminative validity in immediate and persistent pain for the age groups < or =3 and >3 yr were also studied. The children's behaviour was videotaped before and after surgery, before analgesia had been given in the post-anaesthesia care unit (PACU), and on the ward. Four observers then rated pain behaviour from rearranged videotapes. The decision to treat pain was based on routine practice and was made by a researcher unaware of the rating procedure. All tools had acceptable content validity and excellent inter-rater and intra-rater reliabilities (intraclass correlation >0.9 and >0.8 respectively). Construct validity was determined by the ability to differentiate the group with no pain before surgery and a high pain level after surgery, before analgesia (P<0.001). The positive correlations among all scales in the PACU and on the ward (r=0.621-0.827, P<0.0001) supported concurrent validity. Use of the kappa statistic indicated that CHEOPS yielded the best agreement with the routine decision to treat pain. The younger and older age groups both yielded very good agreement in the PACU but only moderate agreement on the ward. On the basis of data from this study, we recommend CHEOPS as a valid, reliable and practical tool.
