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Discordance between patient self-reported visual analog scale pain scores and observed pain-related behavior in older
1Department of Anesthesiology, Children's Hospital Medical Center of Akron, OH 44308, USA.
Insights
Healthcare providers
Area of Science:
- Pediatric Pain Management
- Pain Assessment in Children
- Behavioral Pain Observation
Background:
- Accurate pain assessment in children is crucial for effective management.
- Older children may report pain using self-assessment tools like the Visual Analog Scale (VAS).
- Observational pain behaviors can provide complementary information.
Purpose of the Study:
- To evaluate the correlation between children's self-reported pain scores and healthcare providers' observational pain scores.
- To explore the relationship between subjective pain perception and objective behavioral indicators in pediatric patients.
Main Methods:
- A prospective, comparative study was conducted in a pediatric hospital.
- 30 outpatients aged 8-16 years undergoing surgery provided VAS pain scores.
- Three healthcare providers independently assessed pain using behavioral observation scales.
Main Results:
- Pain-related behavior scores showed good interrater reliability (ICC = 0.83).
- Correlation between self-reported VAS scores and observed behavioral pain scores was variable and minimal.
- Healthcare providers' interpretations of pain behaviors showed weak agreement with patient self-reports.
Conclusions:
- A weak relationship exists between older children's self-perceived pain and their observable pain behaviors.
- Healthcare providers' interpretations of pain behaviors may not consistently align with patient self-reports.
- Further research is needed to refine pain assessment tools for pediatric populations.
Study Objective:
To assess the correlation in an older pediatric population between patient self-reported visual analog scale (VAS) pain scores and observational pain-related behavior scores.
Design:
Prospective, comparative study.
Setting:
Inpatient surgical units of a free-standing children's hospital.
Patients:
30 ASA physical status I and II outpatients, 8 to 16 years of age, undergoing a variety of orthopedic, plastic, urologic, and general surgical procedures.
Interventions:
Each patient underwent a single assessment of pain intensity on the first postoperative day.
Measurements And Main Results:
Three health care providers (a clinical nurse specialist, a registered nurse with extensive pediatric experience, and a child life specialist) simultaneously generated an independent pain-related behavioral score (range of 0 = no pain to 100 = worst pain possible) based on their subjective perceptions of the patient's observed facial expression, activity level, and breathing pattern. The patient was then asked to provide a self-reported VAS pain score (range of 0 = "no pain" with a smiling face, to 100 = "worst pain ever" with a frowning face). A single set of such concurrent pain scores was obtained once from each study patient. The pain-related behavior scores displayed a satisfactory interrater reliability, with an observed interclass correlation coefficient (Cohen's kappa value) of 0.83. When compared with a patient's self-reported VAS score, the three pain related behavioral scores generated by each health care provider for a given patient exhibited both variable and minimal correlation.
Conclusions:
A tenuous relationship may exist between on older child's own perception of pain intensity and his or her behavioral expression of that pain as interpreted by a health care provider.