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Pediatric Pain Assessment in the Emergency Department: Patient and Caregiver Agreement Using the Wong-Baker FACES and

Simone L Lawson, Melanie M Hogg1, Charity G Moore2

  • 1From the Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.

Pediatric Emergency Care
|July 24, 2019
PubMed

Insights

Caregiver and child pain ratings showed poor agreement using the Wong-Baker FACES (WBF) and Faces Pain Scale-Revised (FPS-R) in pediatric emergency departments. Self-reporting pain is recommended when possible.

Area of Science:

  • Pediatric Emergency Medicine
  • Pain Assessment
  • Child Psychology

Background:

  • Accurate pain assessment in children is crucial for effective treatment in pediatric emergency departments (EDs).
  • Existing pain scales like the Wong-Baker FACES (WBF) and Faces Pain Scale-Revised (FPS-R) are commonly used.
  • Understanding the agreement between child self-reports and caregiver proxy reports is vital for reliable pain evaluation.

Purpose of the Study:

  • To evaluate the concordance between pediatric patients' self-reported pain and their caregivers' proxy ratings.
  • To compare the agreement levels using two distinct visual analog pain scales: Wong-Baker FACES (WBF) and Faces Pain Scale-Revised (FPS-R).
  • To determine the reliability of caregiver pain assessments in acute pediatric pain scenarios within an emergency department setting.

Main Methods:

  • Prospective, observational study involving 46 children aged 3 to 7.5 years with acute pain in a pediatric ED.
  • Children and their caregivers independently completed both the WBF and FPS-R pain scales at two time points.
  • Intraclass correlations (ICCs) and Bland-Altman plots were utilized to analyze the agreement between child and caregiver pain scores.

Main Results:

  • Initial assessment showed low ICCs: 0.33 for FPS-R and 0.22 for WBF between children and caregivers.
  • Repeat assessments yielded similar low ICCs: 0.31 for FPS-R and 0.26 for WBF.
  • Bland-Altman analysis indicated poor agreement between child and caregiver pain ratings, without systematic bias.

Conclusions:

  • Significant disagreement exists between children's self-reported pain and caregivers' proxy ratings using both WBF and FPS-R scales.
  • Caregiver pain assessments should not replace direct patient self-reporting in pediatric acute pain evaluations whenever feasible.
  • Findings highlight the need for caution when relying solely on caregiver reports for pediatric pain management in emergency settings.
Abstract

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