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Pain assessment in children undergoing venipuncture: the Wong-Baker faces scale versus skin conductance fluctuations
Francesco Savino1, Liliana Vagliano, Simone Ceratto
1Città della Salute e della Scienza di Torino , Regina Margherita Children's Hospital , Dipartimento di Scienze della Sanità Pubblica e Pediatriche , University of Turin , Italy.
Insights
The Wong-Baker Faces Pain Rating Scale (WBFS) underestimated pain in children compared to skin conductance fluctuations (SCF). Age and prior venipuncture experience affected WBFS, while SCF provided consistent pain assessment data.
Area of Science:
- Pediatric Pain Assessment
- Psychophysiology
- Medical Device Evaluation
Background:
- Accurate pain assessment in children is crucial for effective management.
- Subjective pain scales and objective physiological measures have limitations.
- Venipuncture is a common painful procedure in pediatric care.
Purpose of the Study:
- To compare the efficacy of the Wong-Baker Faces Pain Rating Scale (WBFS) and skin conductance fluctuation (SCF) for assessing pain in children during venipuncture.
- To investigate the influence of age and previous venipuncture experience on pain assessment outcomes.
Main Methods:
- One hundred fifty children (aged 5-16 years) underwent venipuncture.
- Pain was assessed using the WBFS (subjective) and SCF (objective) measurements.
- SCF was recorded before, during, and after the procedure.
Main Results:
- WBFS-assessed pain was significantly lower than SCF-assessed pain (p < 0.0001).
- SCF showed significantly higher values during venipuncture compared to before or after (p < 0.0001).
- Age and prior venipuncture experience influenced WBFS scores but not SCF.
Conclusions:
- Skin conductance fluctuation (SCF) offers a more objective and consistent measure of pain during venipuncture in children compared to the Wong-Baker Faces Pain Rating Scale (WBFS).
- The WBFS is influenced by factors like age and previous experiences, potentially leading to underestimation of pain.
- SCF may be a more reliable tool for research and clinical practice in pediatric pain assessment, pending further validation.
Abstract:
The aim of this study was to evaluate the efficacy of the subjective Wong-Baker faces pain rating scale (WBFS) and of the objective skin conductance fluctuation (SCF) test in assessing pain in children undergoing venipuncture. One-hundred and fifty children (aged 5-16 years) entered the study. All underwent venipuncture at the antecubital fossa to collect blood specimens for routine testing in the same environmental conditions. After venipuncture, the children indicated their pain intensity using the WBFS, whereas the number of SCFs was recorded before, during and after venipuncture. So, pain level was measured in each child with WBFS and SCF. We found that the level of WBFS-assessed pain was lower in all children, particularly those above 8 years of age, than SCF-assessed pain (p < 0.0001). Moreover, the number of SCFs was significantly higher during venipuncture than before or after venipuncture (p < 0.0001). At multivariate regression analysis, age and previous experience of venipuncture influenced the WBFS (β = -1.81, p < 0.001, and β = -0.86, p < 0.001, respectively) but not SCFs. In conclusion, although both procedures can be useful for research and clinical practice, our findings show that WBFS was affected by age and previous venipuncture, whereas SCF produced uniform data. If verified in other studies, our results should be taken into account when using these tools to evaluate pain in children.
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