Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media?

Abstract

Background: The assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain.

Methods: This cross-sectional study included 426 children (6-35 months) with symptoms suggestive of AOM. We surveyed symptoms and pain via parental interview. As part of the interview, parents assessed their child's pain by using two pain scales: The Faces Pain Scale-Revised (FPS-R) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The outcome of interest was moderate/severe pain. We used the χ2 test or Fisher's test as applicable to compare the severity of pain between three parental pain assessment methods (the parental interview, the FPS-R and the FLACC Scale). We also used multivariable logistic regression models to study the association between the severity of pain and AOM and to study the association between symptoms and the severity of pain.

Results: In children with AOM (n = 201), pain was assessed by parents as moderate/severe in 65% via interview; 90% with the FPS-R; and 91% with the FLACC Scale (P < 0.001). In children without AOM (n = 225), the percentages were 56, 83 and 88%, respectively (P < 0.001). Between children with and without AOM, the occurrence of moderate/severe pain did not differ with any of the pain evaluation methods. Of symptoms, ear pain reported by child and restless sleep were significantly associated with moderate/severe pain, regardless of the pain evaluation method.

Conclusions: It seems that nearly all the children with respiratory tract infection, either with or without AOM, might suffer from moderate/severe pain. Without pain scales, parents may underestimate their child's pain. Of symptoms, ear pain reported by child and restless sleep might indicate pain in children with respiratory tract infection. We suggest that the adaptation of pain scales for parent observation is a possibility in children with respiratory tract infection which, however, requires further studies.

Trial registration: www.clinicaltrials.gov , identifier NCT00299455 . Date of registration: March 3, 2006.

Keywords: Child; Otitis media; Pain scales; Parents; Respiratory tract infection.

Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained from a parent of all children before any study procedures were done. The study protocol was approved by The Ethics Committee of the Hospital District of Southwest Finland.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

“Faces Pain Scale - Revised (FPS-R)”. www.iasp-pain.org/fpsr. Copyright ©2001, International Association for the Study of Pain®. Reproduced with permission

Fig. 2

Distribution of the Faces Pain Scale-Revised (FPS-R) scores in children in the AOM group and in children in the non-AOM group. The numbers below the bars show the number of children with the score, indicating the numerator (n)

Fig. 3

Distribution of the Face, Legs, Activity, Cry, Consolability (FLACC) Scale scores in children in the AOM group and in children in the non-AOM group. The numbers below the bars show the number of children with the score, indicating the numerator (n)

Fig. 4

a, b The occurrence of none/mild and moderate/severe pain in the AOM group (a) and in the non-AOM group (b), assessed by parents via interview, with the Faces Pain Scale-Revised (FPS-R) and with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. Footnote: * Scores 0 and 2 were classified as none/mild pain, and scores 4, 6, 8 and 10 as moderate/severe pain, respectively. †P < 0.001 for the comparison between none/mild pain and moderate/severe pain, assessed by parents with the FPS-R and via interview. ‡ Scores from 0 to 3 were classified as none/mild pain, and scores from 4 to 10 as moderate/severe pain, respectively. §P < 0.001 for the comparison between none/mild pain and moderate/severe pain, assessed by parents with the FLACC Scale and via interview

Fig. 5

The occurrence and the probability of moderate/severe pain, assessed by parents via interview (a), with the Faces Pain Scale-Revised (FPS-R) (b) and with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale (c), in relation to the presence of 15 parentally reported symptoms and ear pain reported by children in 426 children with the suspicion of AOM, analysed with multivariable logistic regression model and adjusted for age, diagnosis of AOM and use of analgesics. Footnote: * Diamonds indicate odds ratio (OR), lines 95% confidence intervals (CI), arrows are added when CI is beyond the scale. †The association of moderate/severe pain with the symptom was 100%