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

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.

Keywords: Child; pain measurement/methods; pain measurement/standards; self report/standards.