Voepel-Lewis Terri, Merkel Sandy, Tait Alan R, Trzcinka Agnieszka, Malviya Shobha
Department of Anesthesiology, Section of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0211, USA.
Anesth Analg. 2002 Nov;95(5):1224-9, table of contents. doi: 10.1097/00000539-200211000-00020.
Pain assessment remains difficult in children with cognitive impairment (CI). In this study, we evaluated the validity and reliability of the Face, Legs, Activity, Cry, Consolability (FLACC) tool for assessing pain in children with CI. Each child's developmental level and ability to self-report pain were evaluated. The child's nurse observed and scored pain with the FLACC tool before and after analgesic administration. Simultaneously, parents scored pain with a visual analog scale, and scores were obtained from children who were able to self-report pain. Observations were videotaped and later viewed by nurses blinded to analgesics and pain scores. One-hundred-forty observations were recorded from 79 children. FLACC scores correlated with parent scores (P < 0.001) and decreased after analgesics (P = 0.001), suggesting good validity. Correlations of total scores (r = 0.5-0.8; P < 0.001) and of each category (r = 0.3-0.8; P < 0.001), as well as measures of exact agreement (kappa = 0.2-0.65), suggest good reliability. Test-retest reliability was supported by excellent correlations (r = 0.8-0.883; P < 0.001) and categorical agreement (r = 0.617-0.935; kappa = 0.400-0.881; P < 0.001). These data suggest that the FLACC tool may be useful as an objective measure of postoperative pain in children with CI.
The FLACC pain assessment tool may facilitate reliable and valid observational pain assessment in children with cognitive impairment who cannot self-report their pain. Objective pain assessment is important to facilitate effective postoperative pain management in these vulnerable children.
对于认知障碍（CI）儿童，疼痛评估仍然困难。在本研究中，我们评估了面部、腿部、活动、哭闹、可安慰性（FLACC）工具在评估CI儿童疼痛方面的有效性和可靠性。评估了每个儿童的发育水平和自我报告疼痛的能力。儿童的护士在给予镇痛药前后使用FLACC工具观察并对疼痛进行评分。同时，家长使用视觉模拟量表对疼痛进行评分，对于能够自我报告疼痛的儿童也获取其评分。观察过程进行录像，之后由对镇痛药和疼痛评分不知情的护士观看。从79名儿童中记录了140次观察结果。FLACC评分与家长评分相关（P < 0.001），且在给予镇痛药后降低（P = 0.001），表明有效性良好。总分相关性（r = 0.5 - 0.8；P < 0.001）以及各分类相关性（r = 0.3 - 0.8；P < 0.001），还有精确一致性测量（kappa = 0.2 - 0.65），表明可靠性良好。重测信度得到了出色相关性（r = 0.8 - 0.883；P < 0.001）和分类一致性（r = 0.617 - 0.935；kappa = 0.400 - 0.881；P < 0.001）的支持。这些数据表明，FLACC工具可能作为评估CI儿童术后疼痛的客观指标有用。
FLACC疼痛评估工具可能有助于对无法自我报告疼痛的认知障碍儿童进行可靠且有效的观察性疼痛评估。客观的疼痛评估对于促进这些脆弱儿童的有效术后疼痛管理很重要。
