Author:
Robin I. Luffy, MSN, RN,
CPNP
Research has shown that children do experience pain. Describing the amount of pain they are experiencing is a difficult task for many children. Studies have demonstrated that several tools: FACES Scale, Oucher Scale, and Visual Analog Scale help children quantify the intensity of their pain. Although studies showed these tools to be valid and reliable in pediatric populations, most studies' populations consisted of primarily Caucasian children. Absent from the literature are culturally sensitive studies that document validity, reliability, or preference when non-Caucasian children use these tools.
The purpose of this study was to compare validity, reliability, and preference of 3 pain intensity assessment tools: the African-American Oucher Scale, the Wong-Baker FACES Scale, and the Visual Analog Scale (VAS), in African-American children between 3 and 18 years of age. This methodological study's population consisted of 100 children seen in the outpatient Pediatric Sickle Cell Clinic or satellite clinics of Children's Medical Center of Dallas. Patients were eligible if identified by a parent as African-American in origin, English speaking, alert and not in pain at the time of testing, had no known developmental delays, and younger children (age three) demonstrated the ability to seriate 6 sizes of a geometric shape.
The mean age of this sample was 8.52 years with a median age of 8 years. Fifty-one subjects were males and 49 were females, all with sickle cell disease. Subjects were selected by convenience sampling and then asked during an interview to use numbers, faces, pictures, and lines printed on paper to describe how much pain they had experienced during a previous painful procedure. In addition, they were asked to rank order the scales according to preference. The FACES Scale was chosen by 56% of the children as their first preference, Oucher Scale by 26%, and VAS by 18%. Validity (how accurately the tools measured pain) was highest in the FACES Scale and the Oucher at 0.7. Reliability (how consistently the tools measured pain) was highest in the Oucher (0.7) and lowest in the VAS (0.45).
The study findings indicated that the FACES and Oucher Scales were appropriate to use with African-American children; however, the VAS was not preferred by the children and had limited validity and reliability. The results of this study indicated that clinically, the FACES Scale is most useful in pediatrics.
Robin Luffy, MSN, RN, CPNP, c/o Peter N. Schochet, MD, PAApril 22, 1996
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