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Published on: December 19, 2016
Validity of Simplified Versus Standard Self-Report Measures of Pain Intensity in Preschool-Aged Children Undergoing
Anthony S Emmott1, Nicholas West2, Guohai Zhou3
1Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Two new simplified pain scales show promise for assessing pain in 4-year-olds, improving on existing methods. However, quantitative pain rating remains difficult for 3-year-olds.
Area of Science:
- Pediatric Pain Management
- Child Psychology
- Clinical Assessment Tools
Background:
- Current self-report pain scales lack age-specific data for 3- and 4-year-olds.
- Preschool-aged children often lack the cognitive development for standard pain scales.
- Novel simplified scales are needed to accurately assess pain in young children.
Purpose of the Study:
- To evaluate the validity and feasibility of two novel simplified pain scales for preschool-aged children.
- To compare the performance of simplified scales against a standard scale (Faces Pain Scale-Revised).
- To assess the utility of simplified pain scales in children undergoing routine blood collection.
Main Methods:
- 180 children aged 3-6 years were recruited for routine blood collection.
- Children were randomly assigned two of three scales: Simplified Faces Pain Scale (S-FPS), Simplified Concrete Ordinal Scale (S-COS), and Faces Pain Scale-Revised (FPS-R).
- Pain was self-reported using scales before, immediately after, and 5 minutes post-venipuncture, and also assessed via observational (Face Legs Activity Cry Consolability) methods.
Main Results:
- The S-FPS and S-COS improved the ability to discriminate pain from no pain in 4-year-olds compared to FPS-R.
- Correlation between simplified scales and observational pain assessment was moderate to strong.
- Cooperation rates were similar across all tested self-report pain scales.
Conclusions:
- Simplified pain scales, S-FPS and S-COS, enhance pain assessment for 4-year-olds.
- Quantitative pain rating remains a challenge for 3-year-olds using current simplified methods.
- These simplified scales show potential for clinical use in children as young as 4 years old.
Abstract:
There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children. Most preschool-aged children also lack the necessary cognitive development to use standard scales. We aimed to evaluate the validity and feasibility of 2 novel simplified scales (Simplified Faces Pain Scale, S-FPS; Simplified Concrete Ordinal Scale, S-COS) for preschool-aged children. These simplified scales used a 2-step self-report method: children were first asked whether they have pain (yes/no); only if yes, then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe. We recruited 180 3- to 6-year-old children undergoing routine blood collection. Each child was randomly assigned 2 of 3 scales-S-FPS, S-COS, Faces Pain Scale-Revised (FPS-R)-to self-report pain before venipuncture, immediately after, and 5 minutes later, using both scales at each time-point. Pain was also assessed using observation (Face Legs Activity Cry Consolability) at each time point. The ability to discriminate pain from no pain was improved with S-FPS and S-COS, compared with the FPS-R, among 4-year-olds, but not 3-year-olds. Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales. The simplified scales can improve and simplify pain assessment for 4-year-olds. Quantitative pain rating remains challenging for 3-year-olds.
Perspective:
This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling. These scales demonstrated good validity and feasibility compared with the FPS-R, suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years.
