Systematic Literature Review of Pediatric Pain Measures

Wednesday, 1 August 2012: 11:10 AM

Kuo-Li Chao, RN, BSN
Department of Nursing, Department of Neurology, Yuan's General Hospital/ Fooying University, Lin-ya district, Taiwan
Pei-Hsin Yang, RN, BSN
Neonatal intermediate care unit, Kaohsiung Chang Gung Memorial Hospital , Fooyin University, Kaohsiung City, Taiwan

Learning Objective 1: Systematic review of child behavior check list, the validity and effectiveness of the self reported questionnaire

Learning Objective 2: how the child behavior check list and self reported questionnaire are being utilized.

Abstract: 

Articles on pediatric behavioral scales were reviewed to elucidate usage of pain assessment tools in clinical practice. 

Methods: 

A literature search was performed in the MEDLINE, PubMed, Cochrane Library, CINAHL, SODL, CEPS and master thesis databases for systematic reviews published from 2000 to 2011 using the following search terms: pain, child, children, childhood, systematic review, and instrument.  A total of 112 articles were identified.  7 articles on child pain assessment instrument met the inclusion criteria.

Results:

Pediatric pain assessment scales can be either observational scales or self-reported measure.  20 articles on observational scales were identified.  CHEOPS, FLACC, PPPM, COMFORT, POCIS scales were suggested to be used in hospitalized, post-operative, critical care, and burn patients.  A total of 34 single-item self-report measures were found.  The most often used scale for research purposes were Pieces of hurt tool, FPS, Oucher, Wong-Baker FACES pain score, and VAS.  The scales mentioned above were reliable, effective, and can be utilized in different types of diseases. 

Conclusion:

Pain is subjective.  In order to accurately assess pain in pediatric population, behavioral scales, self-report measure, and physiologic indicators should be incorporated.  In pediatric population pain could not be well expressed due to immature cognition.  Self-report measure is not a reliable tool when used in patients less than 6-year-old.  Pain will be assessed more accurately when self-report measure is utilized in combination with a reliable and effective behavioral observation scale.   In the future, research should be directed to comparison of the physiologic indicators with observational scales vs self-report measure to validate the effectiveness of different scales.