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Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients
Gregory Garra1, Adam J Singer, Breena R Taira
1Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA. ggarra@notes.cc.sunysb.edu
Insights
The Wong-Baker FACES Pain Rating Scale (WBS) is a reliable tool for assessing acute pain in children within the emergency department (ED). This study found an excellent correlation between the WBS and the visual analog scale (VAS) in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Pain Assessment
- Clinical Validation
Background:
- The Wong-Baker FACES Pain Rating Scale (WBS) is commonly used for pediatric pain assessment but has limited validation in emergency department (ED) settings for acute pain.
- Previous validation primarily focused on chronic pain outside the ED.
Purpose of the Study:
- To validate the Wong-Baker FACES Pain Rating Scale (WBS) in children presenting to the ED with acute pain.
- To determine the correlation between the WBS and the visual analog scale (VAS).
- To establish a corresponding mean VAS value for each WBS face category.
Main Methods:
- Prospective, observational study involving 120 children (ages 8-17) in a pediatric ED.
- Children used both the WBS (ordinal scale) and a 100-mm VAS (continuous scale) to rate pain severity.
- Statistical analysis included ANOVA to compare VAS scores across WBS categories and Spearman's correlation to assess agreement.
Main Results:
- The mean VAS scores increased uniformly across WBS categories.
- ANOVA confirmed significant differences in mean VAS scores between WBS face groups.
- Excellent agreement was found between the WBS and VAS (Spearman's rho = 0.90).
Conclusions:
- The WBS demonstrates excellent correlation with the VAS in children with acute pain in the ED.
- The WBS is a valid and reliable tool for assessing acute pain severity in pediatric emergency settings.
- Findings support the use of WBS in research for pain management strategies.
Objectives:
The Wong-Baker FACES Pain Rating Scale (WBS), used in children to rate pain severity, has been validated outside the emergency department (ED), mostly for chronic pain. The authors validated the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale (VAS) for each face of the WBS and determined the relationship between the WBS and VAS. The hypothesis was that the pain severity ratings on the WBS would be highly correlated (Spearman's rho > 0.80) with those on a VAS.
Methods:
This was a prospective, observational study of children ages 8-17 years with pain presenting to a suburban, academic pediatric ED. Children rated their pain severity on a six-item ordinal faces scale (WBS) from none to worst and a 100-mm VAS from least to most. Analysis of variance (ANOVA) was used to compare mean VAS scores across the six ordinal categories. Spearman's correlation (rho) was used to measure agreement between the continuous and ordinal scales.
Results:
A total of 120 patients were assessed: the median age was 13 years (interquartile range [IQR] = 10-15 years), 50% were female, 78% were white, and six patients (5%) used a language other than English at home. The most commonly specified locations of pain were extremity (37%), abdomen (19%), and back/neck (11%). The mean VAS increased uniformly across WBS categories in increments of about 17 mm. ANOVA demonstrated significant differences in mean VAS across face groups. Post hoc testing demonstrated that each mean VAS was significantly different from every other mean VAS. Agreement between the WBS and VAS was excellent (rho = 0.90; 95% confidence interval [CI] = 0.86 to 0.93). There was no association between age, sex, or pain location with either pain score.
Conclusions:
The VAS was found to have an excellent correlation in older children with acute pain in the ED and had a uniformly increasing relationship with WBS. This finding has implications for research on pain management using the WBS as an assessment tool.
