Pediatric Pain Assessment in the Emergency Department: Patient and Caregiver Agreement Using the Wong-Baker FACES and the Faces Pain Scale–Revised. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Lawson, Simone L.; Hogg, Melanie M.; Moore, Charity G.; Anderson, William E.; Osipoff, Paul S.; Runyon, Michael S.; Reynolds, Stacy L.
• Is Part Of: Pediatric emergency care. Volume 37:Issue 12(2021)
• Publication Date: 2021-12
• Subjects: pain assessment -- Wong-Baker FACES -- Faces Pain Scale–Revised -- agreement -- parent -- caregiver; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000001837
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objective: This study aimed to assess the agreement between patients presenting to the pediatric emergency department (ED) with acute pain and their caregivers when using the Wong-Baker FACES (WBF) and Faces Pain Scale–Revised (FPS-R). Methods: This was a prospective, observational study examining patients 3 to 7.5 years old presenting to a pediatric ED with acute pain. Participants completed the WBF and FPS-R twice during their ED evaluation. Caregivers rated their child's pain using both the WBF and FPS-R at the same time points. Intraclass correlations (ICCs) were calculated between caregiver and child reports at each time point, and Bland-Altman plots were created. Results: Forty-six subjects were enrolled over 5 months. Mean age was 5.5 ± 1.2 years. Average initial child pain scores were 6.6 ± 2.8 (WBF) and 6.1 ± 3.3 (FPS-R), and repeat scores were 3.3 ± 3.4 (WBF) and 3.1 ± 3.3 (FPS-R). Average initial caregiver pain scores were 6.3 ± 2.4 (WBF) and 6.2 ± 2.3 (FPS-R), and repeat scores were 3.4 ± 2.0 (WBF) and 3.4 ± 2.1 (FPS-R). On initial assessment, ICCs between children and caregivers using the FPS-R and WBF were 0.33 and 0.22, respectively. On repeat assessment, the ICCs were 0.31 for FPS-R and 0.26 for WBF. Bland-Altman plots showed poor agreement but no systematic bias. Conclusion: There was poor agreement between caregivers and children when using the WBF and FPS-R for assessment of acute pain in the ED. Caregiver report should not be used as a substitute for self-report of pain if possible.