This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Voepel-Lewis, T. Articles by Malviya, S. Search for Related Content PubMed PubMed Citation Articles by Voepel-Lewis, T. Articles by Malviya, S. Related Collections Pediatrics Pain

---

PEDIATRIC ANESTHESIA

The Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Observational Tool as a Measure of Pain in Children with Cognitive Impairment

Department of Anesthesiology, Section of Pediatrics, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan

Address correspondence and reprint requests to Terri Voepel-Lewis, RN, Department of Anesthesiology, University of Michigan Health Systems, F3900/Box 0211, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0211. Address e-mail to terriv{at}umich.edu

Pain assessment remains difficult in children with cognitive impairment (CI). In this study, we evaluated the validity and reliability of the Face, Legs, Activity, Cry, Consolability (FLACC) tool for assessing pain in children with CI. Each child’s developmental level and ability to self-report pain were evaluated. The child’s nurse observed and scored pain with the FLACC tool before and after analgesic administration. Simultaneously, parents scored pain with a visual analog scale, and scores were obtained from children who were able to self-report pain. Observations were videotaped and later viewed by nurses blinded to analgesics and pain scores. One-hundred-forty observations were recorded from 79 children. FLACC scores correlated with parent scores (P < 0.001) and decreased after analgesics (P = 0.001), suggesting good validity. Correlations of total scores (r = 0.5–0.8; P < 0.001) and of each category (r = 0.3–0.8; P < 0.001), as well as measures of exact agreement ( = 0.2–0.65), suggest good reliability. Test-retest reliability was supported by excellent correlations (r = 0.8–0.883; P < 0.001) and categorical agreement (r = 0.617–0.935; = 0.400–0.881; P < 0.001). These data suggest that the FLACC tool may be useful as an objective measure of postoperative pain in children with CI.

IMPLICATIONS: The FLACC pain assessment tool may facilitate reliable and valid observational pain assessment in children with cognitive impairment who cannot self-report their pain. Objective pain assessment is important to facilitate effective postoperative pain management in these vulnerable children.

This article has been cited by other articles:

				F. E. Babl, C. Goldfinch, C. Mandrawa, D. Crellin, R. O'Sullivan, and S. Donath Does Nebulized Lidocaine Reduce the Pain and Distress of Nasogastric Tube Insertion in Young Children? A Randomized, Double-Blind, Placebo-Controlled Trial Pediatrics, June 1, 2009; 123(6): 1548 - 1555. [Abstract] [Full Text] [PDF]

				F. D. Yates Parent or Nurse-Controlled Analgesia for Pain Control in Developmentally Delayed Children AAP Grand Rounds, March 1, 2009; 21(3): 32 - 32. [Full Text] [PDF]

				C. M. Darnell, J. Thompson, D. Stromberg, L. Roy, and P. Sheeran Effect of Low-Dose Naloxone Infusion on Fentanyl Requirements in Critically Ill Children Pediatrics, May 1, 2008; 121(5): e1363 - e1371. [Abstract] [Full Text] [PDF]

				T. Voepel-Lewis, S. Malviya, A. R. Tait, S. Merkel, R. Foster, E. J. Krane, and P. J. Davis A Comparison of the Clinical Utility of Pain Assessment Tools for Children with Cognitive Impairment Anesth. Analg., January 1, 2008; 106(1): 72 - 78. [Abstract] [Full Text] [PDF]

				M. Vaughan, E. A. Paton, A. Bush, and J. Pershad Does Lidocaine Gel Alleviate the Pain of Bladder Catheterization in Young Children? A Randomized, Controlled Trial Pediatrics, October 1, 2005; 116(4): 917 - 920. [Abstract] [Full Text] [PDF]

				D. O'Rourke The Measurement of Pain in Infants, Children, and Adolescents: From Policy to Practice Physical Therapy, June 1, 2004; 84(6): 560 - 570. [Full Text] [PDF]

				R. F. Howard Current Status of Pain Management in Children JAMA, November 12, 2003; 290(18): 2464 - 2469. [Abstract] [Full Text] [PDF]

				P. C. Walker and D. S. Wagner Treatment of Pain in Pediatric Patients Journal of Pharmacy Practice, August 1, 2003; 16(4): 261 - 275. [Abstract] [PDF]