Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score.
Journal
European journal of pain (London, England)
ISSN: 1532-2149
Titre abrégé: Eur J Pain
Pays: England
ID NLM: 9801774
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
12
06
2020
accepted:
08
01
2021
pubmed:
12
1
2021
medline:
28
4
2021
entrez:
11
1
2021
Statut:
ppublish
Résumé
Behavioural pain scales are recommended to assess postoperative pain for children who are too young to use self-report tools. Their main limitation is underestimation of pain in the days following an intervention. Although relevant, facial expression is not used in daily clinical practice. This prospective study aimed to assess the validity and reliability of the Facial Action Summary Score (FASS), a five-item scale, to assess postoperative pain until hospital discharge in children <7 years. Assessments of pain and anxiety of 123 children using FASS and validated scales were used to study the psychometric validity of the FASS in clinical practice. The content validity was previously investigated in a development study. The internal validity of the FASS was high with excellent reliability (intraclass coefficient = 0.94) and a high Cronbach α (0.89). Convergent validity with pain scales (FLACC [Face, Legs, Activity, Cry, Consoling] and FPS-R [Faces Pain Scale - Revised]) was high (r > 0.8). Sensitivity to change was verified by a significant decrease in the score after rescue analgesia. For a threshold of 2/5, the FASS shows excellent specificity (97%) and sensitivity (82%). The low number of false negatives is the main strength of this tool. This work highlights the interest in using facial expression in daily clinical practice to manage postoperative pain. The FASS is easy to use with excellent psychometric properties and is particularly sensitive to measure pain in the days following surgery. The aim of this study was to prove that facial expression of pain can be used in clinical practice to measure postoperative pain in children. The reduced number of false negatives is the main strength of this tool.
Sections du résumé
BACKGROUND
Behavioural pain scales are recommended to assess postoperative pain for children who are too young to use self-report tools. Their main limitation is underestimation of pain in the days following an intervention. Although relevant, facial expression is not used in daily clinical practice. This prospective study aimed to assess the validity and reliability of the Facial Action Summary Score (FASS), a five-item scale, to assess postoperative pain until hospital discharge in children <7 years.
METHODS
Assessments of pain and anxiety of 123 children using FASS and validated scales were used to study the psychometric validity of the FASS in clinical practice.
RESULTS
The content validity was previously investigated in a development study. The internal validity of the FASS was high with excellent reliability (intraclass coefficient = 0.94) and a high Cronbach α (0.89). Convergent validity with pain scales (FLACC [Face, Legs, Activity, Cry, Consoling] and FPS-R [Faces Pain Scale - Revised]) was high (r > 0.8). Sensitivity to change was verified by a significant decrease in the score after rescue analgesia. For a threshold of 2/5, the FASS shows excellent specificity (97%) and sensitivity (82%). The low number of false negatives is the main strength of this tool.
CONCLUSIONS
This work highlights the interest in using facial expression in daily clinical practice to manage postoperative pain. The FASS is easy to use with excellent psychometric properties and is particularly sensitive to measure pain in the days following surgery.
SIGNIFICANCE
The aim of this study was to prove that facial expression of pain can be used in clinical practice to measure postoperative pain in children. The reduced number of false negatives is the main strength of this tool.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1081-1090Informations de copyright
© 2021 European Pain Federation - EFIC®.
Références
Association of Paediatric Anaesthetists of Great Britain and Ireland. (2012). Good practice in postoperative and procedural pain management, 2nd edition. Paediatric Anaesthesia, 22, 1-79.
Bai, J., & Jiang, N. (2015). Where are we: A systematic evaluation of the psychometric properties of pain assessment scales for use in Chinese children. Pain Management Nursing, 16, 617-631.
Birnie, K. A., Hundert, A. S., Lalloo, C., Nguyen, C., & Stinson, J. N. (2019). Recommendations for selection of self-report pain intensity measures in children and adolescents: A systematic review and quality assessment of measurement properties. Pain, 160, 5-18.
Breivik, H., Borchgrevink, P. C., Allen, S. M., Rosseland, L. A., Romundstad, L., Hals, E. K. B., Kvarstein, G., & Stubhaug, A. (2008). Assessment of pain. British Journal of Anaesthesia, 101, 17-24.
Bringuier, S., Dadure, C., Raux, O., Dubois, A., Picot, M.-C., & Capdevila, X. (2009). The perioperative validity of the visual analog anxiety scale in children: A discriminant and useful instrument in routine clinical practice to optimize postoperative pain management. Anesthesia and Analgesia, 109, 737-744.
Bringuier, S., Picot, M.-C., Dadure, C., Rochette, A., Raux, O., Boulhais, M., & Capdevila, X. (2009). A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations. Pain, 145, 60-68.
Chang, J., Versloot, J., Fashler, S. R., McCrystal, K. N., & Craig, K. D. (2015). Pain assessment in children: Validity of facial expression items in observational pain scales. The Clinical Journal of Pain, 31, 189-197.
Chiaretti, A., Pierri, F., Valentini, P., Russo, I., Gargiullo, L., & Riccardi, R. (2013). Current practice and recent advances in pediatric pain management. European Review for Medical and Pharmacological Sciences, 17(Suppl 1), 112-126.
Crellin, D. J., Harrison, D., Santamaria, N., & Babl, F. E. (2015). Systematic review of the face, legs, activity, cry and consolability scale for assessing pain in infants and children: Is it reliable, valid, and feasible for use? Pain, 156, 2132-2151.
Dadure, C., Marie, A., Seguret, F., & Capdevila, X. (2015). One year of anaesthesia in France: A comprehensive survey based on the national medical information (PMSI) database. Part 1: In-hospital patients. Anaesthesia, Critical Care & Pain Medicine, 34, 191-197.
DiLorenzo, M. G., Pillai Riddell, R., Flora, D. B., & Craig, K. D. (2018). Infant clinical pain assessment: Core behavioral cues. The Journal of Pain: Official Journal of the American Pain Society, 19, 1024-1032. https://doi.org/10.1016/j.jpain.2018.03.016
Ekman, P., Facial, W. V. Facial action coding system. (1978).
Fein, J. A., Zempsky, W. T., Cravero, J. P. (2012). Medicine CoPEMaSoAaP, Pediatrics AAo. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics, 130, e1391-1405. https://doi.org/10.1542/peds.2012-2536
Galinkin, J. L., Fazi, L. M., Cuy, R. M., Chiavacci, R. M., Kurth, C. D., Shah, U. K., Jacobs, I. N., & Watcha, M. F. (2000). Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology, 93, 1378-1383. https://doi.org/10.1097/00000542-200012000-00006
Gilbert, C. A., Lilley, C. M., Craig, K. D., McGrath, P. J., Court, C. A., Bennett, S. M., & Montgomery, C. J. (1999). Postoperative pain expression in preschool children: Validation of the child facial coding system. The Clinical Journal of Pain, 15, 192-200. https://doi.org/10.1097/00002508-199909000-00006
Grunau, R. V., & Craig, K. D. (1987). Pain expression in neonates: Facial action and cry. Pain, 28, 395-410. https://doi.org/10.1016/0304-3959(87)90073-X
Hicks, C. L., von Baeyer, C. L., Spafford, P. A., van Korlaar, I., & Goodenough, B. (2001). The faces pain scale-revised: Toward a common metric in pediatric pain measurement. Pain, 93, 173-183. https://doi.org/10.1016/S0304-3959(01)00314-1
Jöhr, M. (2002). Postanaesthesia excitation. Paediatric Anaesthesia, 12, 293-295. https://doi.org/10.1046/j.1460-9592.2002.00799.x
Joshi, G. P., & Ogunnaike, B. O. (2005). Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiology Clinics of North America, 23, 21-36. https://doi.org/10.1016/j.atc.2004.11.013
Kappesser, J., de Laffolie, J., Faas, D., Ehrhardt, H., & Hermann, C. (2019). Comparison of two neonatal pain assessment tools (Children and Infant's Postoperative Pain Scale and the Neonatal Facial Coding System-Revised) and their relations to clinicians' intuitive pain estimates. European Journal of Pain (London, England), 23, 708-718. https://doi.org/10.1002/ejp.1338
Malviya, S., Voepel-Lewis, T., Burke, C., Merkel, S., & Tait, A. R. (2006). The revised FLACC observational pain tool: Improved reliability and validity for pain assessment in children with cognitive impairment. Paediatric Anaesthesia, 16, 258-265. https://doi.org/10.1111/j.1460-9592.2005.01773.x
Manworren, R. C. B., & Hynan, L. S. (2003). Clinical validation of FLACC: Preverbal patient pain scale. Pediatric Nursing, 29, 140-146.
McGrath, P. A. (1987). An assessment of children's pain: A review of behavioral, physiological and direct scaling techniques. Pain, 31, 147-176.
Merkel, S. I., Voepel-Lewis, T., Shayevitz, J. R., & Malviya, S. (1997). The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23, 293-297.
Mukaka, M. M. (2012). Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Medical Journal: The Journal of Medical Association of Malawi, 24, 69-71.
Peters, J. W. B., Koot, H. M., Grunau, R. E., de Boer, J., van Druenen, M. J., Tibboel, D., & Duivenvoorden, H. J. (2003). Neonatal facial coding system for assessing postoperative pain in infants: Item reduction is valid and feasible. The Clinical Journal of Pain, 19, 353-363. https://doi.org/10.1097/00002508-200311000-00003
Prkachin, K. M. (1992). The consistency of facial expressions of pain: A comparison across modalities. Pain, 51, 297-306. https://doi.org/10.1016/0304-3959(92)90213-U
Ramelet, A.-S., Abu-Saad, H. H., Rees, N., & McDonald, S. (2004). The challenges of pain measurement in critically ill young children: A comprehensive review. Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses, 17, 33-45. https://doi.org/10.1016/S1036-7314(05)80048-7
Ringblom, J., Wåhlin, I., & Proczkowska, M. (2018). A psychometric evaluation of the pediatric anesthesia emergence delirium scale. Paediatric Anaesthesia, 28, 332-337. https://doi.org/10.1111/pan.13348
Schiavenato, M. (2008). Facial expression and pain assessment in the pediatric patient: The primal face of pain. J Spec Pediatr Nurs, 13, 89-97. https://doi.org/10.1111/j.1744-6155.2008.00140.x
Somaini, M., Engelhardt, T., Fumagalli, R., & Ingelmo, P. M. (2016). Emergence delirium or pain after anaesthesia-how to distinguish between the two in young children: A retrospective analysis of observational studies. British Journal of Anaesthesia, 116, 377-383.
Somaini, M., Sahillioglu, E., Marzorati, C., Lovisari, F., Engelhardt, T., & Ingelmo, P. M. (2015). Emergence delirium, pain or both? A Challenge for Clinicians. Paediatr Anaesth, 25, 524-529.
Stinson, J. N., Kavanagh, T., Yamada, J., Gill, N., & Stevens, B. (2006). Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain, 125, 143-157.
Tripi, P. A., Palermo, T. M., Thomas, S., Goldfinger, M. M., & Florentino-Pineda, I. (2004). Assessment of risk factors for emergence distress and postoperative behavioural changes in children following general anaesthesia. Paediatric Anaesthesia, 14, 235-240.
Tsze, D. S., Hirschfeld, G., Dayan, P. S., Bulloch, B., & von Baeyer, C. L. (2018). Defining No pain, mild, moderate, and severe pain based on the faces pain scale-revised and color analog scale in children with acute pain. Pediatric Emergency Care, 34, 537-544.
Tsze, D. S., von Baeyer, C. L., Bulloch, B., & Dayan, P. S. (2013). Validation of self-report pain scales in children. Pediatrics, 132, e971-e979.
Voepel-Lewis, T., Burke, C. N., Jeffreys, N., Malviya, S., & Tait, A. R. (2011a). Do 0-10 numeric rating scores translate into clinically meaningful pain measures for children? Anesthesia and Analgesia, 112, 415-421.
Voepel-Lewis, T., Merkel, S., Tait, A. R., Trzcinka, A., & Malviya, S. (2002). The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesthesia and Analgesia, 95, 1224-1229, Table of Contents.
von Baeyer, C. L. (2006). Children's self-reports of pain intensity: Scale selection, limitations and interpretation. Pain Research & Management, 11, 157-162.
von Baeyer, C. L., & Spagrud, L. J. (2007). Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain, 127, 140-150. https://doi.org/10.1016/j.pain.2006.08.014
Williams, A. C. C. (2002). Facial expression of pain: An evolutionary account. The Behavioral and Brain Sciences, 25, 455-488. https://doi.org/10.1017/S0140525X02000080
Zisk-Rony, R. Y., Lev, J., & Haviv, H. (2015). Nurses' report of in-hospital pediatric pain assessment: Examining challenges and perspectives. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses, 16, 112-120. https://doi.org/10.1016/j.pmn.2014.05.003