Comparison of the Psychometric Properties of the FLACC Scale, the MBPS and the Observer Applied Visual Analogue Scale Used to Assess Procedural Pain

Dianne Crellin, Denise Harrison, Nick Santamaria, Franz E Babl, Dianne Crellin, Denise Harrison, Nick Santamaria, Franz E Babl

Abstract

Purpose: The purpose of this study was to compare the psychometric data and feasibility and clinical utility of the Face Legs, Activity, Cry and Consolability scale (FLACC), the Modified Behavioral Pain Scale (MBPS) and the Visual Analogue Scale for observers (VASobs) used to assess procedural pain in infants and young children.

Patients and methods: Twenty-six clinicians assessed videorecorded segments of 100 infants and young children who underwent a painful and/or distressing procedure in the emergency department using the FLACC scale, the MBPS and the VASobs pain and VASobs distress.

Results: VASobs pain scores were lowest across all procedures and phases of procedures (p < 0.001). Inter-rater reliability was lowest for VASobs pain scores (ICC 0.55). Sensitivity and specificity were highest for FLACC scores (94.9% and 72.5%, respectively) at the lowest cut-off score (pain score two). Observers changed their MBPS scores more often than they changed FLACC or VASobs scores, but FLACC scores were more often incomplete. Reviewers did not consider any scale of use for procedural pain measurement.

Conclusion: The reliability and sensitivity of the FLACC and MBPS were supported by study data but concerns about the capacity of these scales to distinguish between pain- and non-pain-related distress were raised. The VASobs cannot be recommended. Despite its limitations, the FLACC scale may be better suited than other scales for procedural pain measurement.

Keywords: infants; pain measurement; reliability; validity.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2021 Crellin et al.

Figures

Figure 1
Figure 1
Boxplots representing change of scores over time (procedural phases) in the two procedure cohorts (painful and non-painful procedures) for the FLACC scale (A), the MBPS (B), the VASobs pain (C) and the VASobs distress (D).
Figure 2
Figure 2
Scatter plots demonstrating relationships between scores for each scale. Abbreviations: FLACC, Face Legs Activity Cry Consolability; MBPS, Modified Behavioral Pain Scale; VASobs, Visual Analogue Scale observer.

References

    1. Andersen RD, Langius-Eklof A, Nakstad B, Bernklev T, Jylli L. The measurement properties of pediatric observational pain scales: a systematic review of reviews. Int J Nurs Stud. 2017;73:93–101. doi:10.1016/j.ijnurstu.2017.05.010
    1. Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the FLACC scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain. 2015;156(11):2132–2151. doi:10.1097/j.pain.0000000000000305
    1. Crellin DJ, Babl FE, Santamaria N, Harrison D. The MBPS: a systematic review to determine its role in assessing pain in infants and young children. 11th International Symposium on Pediatric Pain. Kuala Lumpur; 2017.
    1. Taddio A, Nulman I, Koren BS, Stevens B, Koren G. A revised measure of acute pain in infants. J Pain Symptom Manage. 1995;10(6):456–463. doi:10.1016/0885-3924(95)00058-7
    1. Schug S, Palmer G, Scott D, Halliwell R, Trinca J. Working Group of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM). In: Acute Pain Management: Scientific Evidence. 4th ed. Melbourne: ANZCA & FPM; 2015.
    1. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293–297.
    1. von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007;127(1–2):150. doi:10.1016/j.pain.2006.08.014
    1. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Task Force on Pain in Infants Children and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–797. doi:10.1542/peds.108.3.793
    1. Howard R, Carter B, Curry J, et al. Good practice in postoperative and procedural pain management. Background. Paediatr Anaesth. 2008;18(Suppl 1):1–3. doi:10.1111/j.1155-5645.2008.02423.x
    1. van Dijk M, Koot HM, Saad HH, Tibboel D, Passchier J. Observational visual analog scale in pediatric pain assessment: useful tool or good riddance? Clin J Pain. 2002;18(5):310–316. doi:10.1097/00002508-200209000-00006
    1. Crellin DJ, Babl FE, Santamaria N, Harrison D. The psychometric properties of the MBPS scale used to assess procedural pain. J Pain. 2018;19(6):660–670. doi:10.1016/j.jpain.2018.01.012
    1. Crellin DJ, Harrison D, Santamaria N, Huque H, Babl FE. The psychometric properties of the FLACC scale used to assess procedural pain. J Pain. 2018;19(8):862–872. doi:10.1016/j.jpain.2018.02.013
    1. Crellin DJ, Harrison D, Hutchinson A, Schuster T, Santamaria N, Babl FE. Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6–42 months. BMJ Open. 2017;7(9):e016225. doi:10.1136/bmjopen-2017-016225
    1. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539–549. doi:10.1007/s11136-010-9606-8
    1. Stata statistical software: release 14 [computer program]. College Station Texas: Stata Corp LP; 2015.
    1. Aitken RC. A growing edge of measurement of feelings [Abridged]. Proc R Soc Med. 1969;62(10):989–993. doi:10.1177/003591576906201005
    1. de Jong A, Baartmans M, Bremer M, et al. Reliability, validity and clinical utility of three types of pain behavioural observation scales for young children with burns aged 0–5 years. Pain. 2010;150(3):561–567. doi:10.1016/j.pain.2010.06.016
    1. Gomez RJ, Barrowman N, Elia S, Manias E, Royle J, Harrison D. Establishing intra- and inter-rater agreement of the face, legs, activity, cry, consolability scale for evaluating pain in toddlers during immunization. Pain Res Manage. 2013;18(6):e124–e128. doi:10.1155/2013/897104
    1. R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2016.
    1. Breau LM, McGrath PJ, Craig KD, Santor D, Cassidy KL, Reid GJ. Facial expression of children receiving immunizations: a principal components analysis of the child facial coding system. Clin J Pain. 2001;17(2):178–186. doi:10.1097/00002508-200106000-00011
    1. Kelly A-M, Powell CV, Williams A. Parent visual analogue scale ratings of children’s pain do not reliably reflect pain reported by child. Pediatr Emerg Care. 2002;18(3):159–162. doi:10.1097/00006565-200206000-00002
    1. Schultz AA, Murphy E, Morton J, Stempel A, Messenger-Rioux C, Bennett K. Preverbal, Early Verbal Pediatric Pain Scale (PEPPS): development and early psychometric testing. J Pediatr Nurs. 1999;14(1):19–27. doi:10.1016/S0882-5963(99)80056-6
    1. Singer AJ, Richman PB, Kowalska A, Thode HC Jr. Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures. Ann Emerg Med. 1999;33(6):652–658.
    1. Krauss BS, Calligaris L, Green SM, Barbi E. Current concepts in management of pain in children in the emergency department. Lancet. 2016;387(10013):83–92. doi:10.1016/S0140-6736(14)61686-X
    1. Chang J, Versloot J, Fashler SR, McCrystal KN, Craig KD. Pain assessment in children: validity of facial expression items in observational pain scales. Clin J Pain. 2015;31(3):189–197. doi:10.1097/AJP.0000000000000103

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