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Validity of Simplified Versus Standard Self-Report Measures of Pain Intensity in Preschool-Aged Children Undergoing Venipuncture

  • Anthony S. Emmott
    Correspondence
    Address reprint requests to Anthony S. Emmott, BSc, Pediatric Anesthesia Research team, Clinical Support Building, Child and Family Research Institute, 950 W 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada.
    Affiliations
    Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Nicholas West
    Affiliations
    Department of Pediatric Anesthesia, BC Children's Hospital, and Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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  • Guohai Zhou
    Affiliations
    Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
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  • Dustin Dunsmuir
    Affiliations
    Department of Pediatric Anesthesia, BC Children's Hospital, and Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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  • Carolyne J. Montgomery
    Affiliations
    Department of Pediatric Anesthesia, BC Children's Hospital, and Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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  • Gillian R. Lauder
    Affiliations
    Department of Pediatric Anesthesia, BC Children's Hospital, and Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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  • Carl L. von Baeyer
    Affiliations
    Department of Clinical Health Psychology and Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Published:January 06, 2017DOI:https://doi.org/10.1016/j.jpain.2016.12.015

      Highlights

      • We proposed two novel scales to simplify pain assessment in preschool-aged children.
      • The two new scales were compared against the Faces Pain Scale-Revised.
      • Four-year-olds discriminated pain from no-pain better with the new scales.
      • In three-year-olds, pain assessment was not improved with the new scales.
      • Most three-year-olds may be able to report presence but not magnitude of pain.

      Abstract

      There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children. Most preschool-aged children also lack the necessary cognitive development to use standard scales. We aimed to evaluate the validity and feasibility of 2 novel simplified scales (Simplified Faces Pain Scale, S-FPS; Simplified Concrete Ordinal Scale, S-COS) for preschool-aged children. These simplified scales used a 2-step self-report method: children were first asked whether they have pain (yes/no); only if yes, then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe. We recruited 180 3- to 6-year-old children undergoing routine blood collection. Each child was randomly assigned 2 of 3 scales—S-FPS, S-COS, Faces Pain Scale-Revised (FPS-R)—to self-report pain before venipuncture, immediately after, and 5 minutes later, using both scales at each time-point. Pain was also assessed using observation (Face Legs Activity Cry Consolability) at each time point. The ability to discriminate pain from no pain was improved with S-FPS and S-COS, compared with the FPS-R, among 4-year-olds, but not 3-year-olds. Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales. The simplified scales can improve and simplify pain assessment for 4-year-olds. Quantitative pain rating remains challenging for 3-year-olds.

      Perspective

      This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling. These scales demonstrated good validity and feasibility compared with the FPS-R, suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years.

      Key words

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      Linked Article

      • Errata
        The Journal of PainVol. 19Issue 4
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          In the article “Validity of Simplified Versus Standard Self-Report Measures of Pain Intensity in Preschool-Aged Children Undergoing Venipuncture,” published in the May 2017 issue (Journal of Pain 2017;18:564–573), the headings were incorrectly labeled in Table 1. The correct headings are “T1 T1 T1 T2 T2 T2 T3 T3 T3”. The amended table is presented below.
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