Cross-validation of a composite pain scale for preschool children within 24 hours of surgery

Abstract

This study was designed to cross-validate a composite measure of the pain scales CHEOPS (Children's Hospital of Eastern Ontario Pain Scale), OPS (Objective Pain Scale, simplified for parent use by replacing blood pressure measurement with observation of body language or posture), TPPPS (Toddler Preschool Postoperative Pain Scale) and FLACC (Face, Legs, Activity, Cry, Consolability) in 167 Thai children aged 1-5.5 yr. The pain scales were translated and tested for content, construct and concurrent validity, including inter-rater and intra-rater reliabilities. Discriminative validity in immediate and persistent pain for the age groups < or =3 and >3 yr were also studied. The children's behaviour was videotaped before and after surgery, before analgesia had been given in the post-anaesthesia care unit (PACU), and on the ward. Four observers then rated pain behaviour from rearranged videotapes. The decision to treat pain was based on routine practice and was made by a researcher unaware of the rating procedure. All tools had acceptable content validity and excellent inter-rater and intra-rater reliabilities (intraclass correlation >0.9 and >0.8 respectively). Construct validity was determined by the ability to differentiate the group with no pain before surgery and a high pain level after surgery, before analgesia (P<0.001). The positive correlations among all scales in the PACU and on the ward (r=0.621-0.827, P<0.0001) supported concurrent validity. Use of the kappa statistic indicated that CHEOPS yielded the best agreement with the routine decision to treat pain. The younger and older age groups both yielded very good agreement in the PACU but only moderate agreement on the ward. On the basis of data from this study, we recommend CHEOPS as a valid, reliable and practical tool.

Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy

“…We used both the faces and CHEOPS pain scales to cross-validate the results, especially in the PACU. 18 We used a visual analogue scale on the ward as it is more sensitive than simple descriptive scales and can be used in children four to five years old. We found that preoperative dexamethasone administration improves pain scores, reduces analgesic requirements, allows earlier oral fluid intake, and improves postoperative swallowing and the quality of oral intake.…”

Avaliação do comportamento de crianças em situações de dor: revisão da literatura

“…7 The TPPPS, in turn, is a scale that can be used to assess pain during and after medical or surgical procedures, on the basis of behavioral indicators. 8,9 In the remainder of the studies, the majority of the instruments whose psychometric qualities were being assessed used ordinal scales, i.e., they categorize attributes and establish a sequential order based on the characteristics of the attribute measured. 6 It should be pointed out that, although ordinal scales are less precise than interval scales, they are generally used with children to obtain self-reported pain assessments since they are easier for children to understand, as is the case of the Oucher Faces Scale, 10 the Faces Pain Scale (FPS) 11,12 and the Facial Affective Scale (FAS).…”

“…11 Nevertheless, in the course of this literature review it was found that ordinal scales are also used by trained observers or by the medical and nursing teams to assess child pain. In these cases the following instruments were used: the Objective Pain Scale (OPS), 8 the Faces, Leg, Activity, Cry and Consolability scale (FLACC), 8,[13][14][15] the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), 8 the Pediatric Pain Profile (PPP), 16 the Alder Hey Triage Pain Score (AHTPS), 17 the Child Facial Coding System (CFCS) 18 and the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R). 19 …”

“…Of all of the scales, the FLACC is of interest since it has been widely used in clinical-hospital contexts and has been used both with preverbal children, 15 and with children at speaking age, with typical 8,9 and atypical development. 13,14 In addition to the FLACC, a further 12 instruments for pain assessment of children in a clinical-hospital context were identified.…”

“…However, six studies performed baseline assessments before a painful procedure, 8,10,16,18,21,23 which indicates a more robust methodology than the others, particularly when using an ordinal measure. Knowledge of baseline pain allows for better pain assessment based on comparison with points in time after the painful procedure.…”