The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy

Pedersen, Line Kjeldgaard; Rahbek, Ole; Nikolajsen, Lone; Möller‐Madsen, Bjarne

doi:10.1016/j.sjpain.2015.06.007

Cited by 24 publications

(24 citation statements)

References 29 publications

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“…The children were also screened for pain by use of validated measurement tools. For children between 2 months and 5 years or for children with developmental problems, the Face, Legs, Activity, Cry, and Consolability (FLACC) scale was applied . For children older than 5 years, the Numerical/Visual Analog Scale was used.…”

Section: Methodsmentioning

confidence: 99%

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An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

Simonsen

Skovby²,

Lisby

2020

Acta Anaesthesiol Scand

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Background Emergence Delirium (ED) is a common complication from anesthesia. Although ED has a short duration, detection is important due to the risk that ED poses for post‐operative complications in the child. The Pediatric Anesthesia Emergence Delirium (PAED) scale has been translated into Danish, but it has not yet been validated. The aim of this study was to investigate the inter‐rater reliability, criterion validity, and responsiveness of the Danish version of the PAED scale as well as to determine the prevalence of ED. Method A sample of 100 post‐operative children were enrolled and assessed with the PAED scale at pre‐specified time intervals. Inter‐rater reliability was assessed independently by 2 raters. For criterion validity, a clinical expert was chosen as the gold standard. Sensitivity and specificity were based on a comparison between the scoring of the raters and the gold standard. Responsiveness was assessed by comparing changes in scores. Prevalence was based on the PAED scale's cut‐off level of ≥10 points. Results A high level of agreement was found, with an intraclass correlation coefficient of 0.85‐0.94. Few outliers appeared in the Bland‐Altman plot. Sensitivity ranged from 70% to 86%, and the specificity of both raters against the gold standard was 100%. Changes in scores were indicative of responsiveness. Prevalence was 13.2%. Conclusion The Danish version of the PAED scale was found reliable and demonstrated high levels of sensitivity and specificity. In addition, it was possible to identify changes in scores over time. Prevalence was in line with existing literature.

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Section: Methodsmentioning

confidence: 99%

“…For children between 2 months and 5 years or for children with developmental problems, the Face, Legs, Activity, Cry, and Consolability (FLACC) scale was applied. 20 For children older than 5 years, the Numerical/Visual Analog Scale was used. These ratings were performed after the PAED scale screening.…”

Section: Data Collectionmentioning

confidence: 99%

An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

Simonsen

Skovby²,

Lisby

2020

Acta Anaesthesiol Scand

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“…Subjective IVIG-AEs such as headache and abdominal pain were evaluated as much as possible by interviewing guardians if patients could not provide any information on subjective IVIG-AEs. Besides, the Face, Legs, Activity, Cry, and Consolability (FLACC) [21][22][23] or revised FLACC (r-FLACC) Scale [24,25] was used for those patients. The guardians rated patients' pain at its highest stage in each category on a scale of 0 to 2, yielding an overall pain score of 0-10 [21][22][23][24][25].…”

Section: Definition Of Adverse Effectsmentioning

confidence: 99%

Predictive factors of first dosage intravenous immunoglobulin-related adverse effects in children

et al. 2020

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BackgroundIntravenous immunoglobulin (IVIG) therapy is used in the treatment of various diseases, and IVIG-related adverse effects (IVIG-AEs) vary from mild to severe. However, the mechanisms underlying IVIG-AEs and the potential predictive factors are not clear. This study investigated whether certain IVIG-AEs can be predicted before IVIG administration. Study design and methodsThis retrospective cohort study at the Division of Neurology, Saitama Children's Medical Center included patients enrolled from 2008 to 2018 who were < 18 years old and received IVIG for the first time. IVIG-AEs were classified according to the Common Terminology Criteria for Adverse Events version 5.0. ResultsA total of 104 patients fulfilled the inclusion criteria. The rate of IVIG-AEs was 37.5% (39/ 104). The most frequent IVIG-AEs were fever (41.0% [16/39]) and headache (38.5% [15/ 39]). AEs were below grade 2 in all except one patient and there were no grade 4 AEs. High serum total protein (TP) level was significantly related to the occurrence of IVIG-AEs (odds ratio, 14.8; 95% confidence interval, 2.4-90.5; P < 0.01). The optimal cutoff TP level was 6.7 g/dL. Although low WBC count and immunoglobulin G level may be predictive risk factors of IVIG-AEs, it was not confirmed in this study. ConclusionIVIG-AEs occurred in 37.5% of cases, and most were mild. TP was the best predictive risk factor of IVIG-AEs before IVIG administration. These results may aid in elucidating the mechanism underlying IVIG-AEs.

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“…found lower interrater agreement for the r‐FLACC categories of Legs and Activity in children with spasticity, but also found highest agreement for the Face and Cry categories and good overall interrater reliability. Others have also found excellent interrater reliability in younger children with CP (intraclass correlation coefficient 0.75) . Additionally, r‐FLACC scores have been found to be very responsive to procedural pain and treatment conditions (i.e.…”

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confidence: 91%

“…Additionally, r‐FLACC scores have been found to be very responsive to procedural pain and treatment conditions (i.e. scores increased on average by 2.23 points after surgery and decreased 4.2 points after analgesia). Together with data from other similar observational scales, such findings suggest that observed distress behaviors can provide an indication of pain severity and response to treatment.…”

mentioning

confidence: 99%

Can pain assessment tools accurately measure pain experience of disabled individuals?

Voepel‐Lewis

2018

Develop Med Child Neuro

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The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy

Abstract: Graphical Abstract.

Cited by 24 publications

References 29 publications

An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

An evaluation of the Danish version of the Pediatric Anesthesia Emergence Delirium scale

Predictive factors of first dosage intravenous immunoglobulin-related adverse effects in children

Can pain assessment tools accurately measure pain experience of disabled individuals?

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