Malviya Shobha, Voepel-Lewis Terri, Burke Constance, Merkel Sandra, Tait Alan R
Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, Ann Arbor, MI 48109-0211, USA.
Paediatr Anaesth. 2006 Mar;16(3):258-65. doi: 10.1111/j.1460-9592.2005.01773.x.
Difficulty with pain assessment in individuals who cannot self-report their pain poses a significant barrier to effective pain management. However, available assessment tools lack consistent reliability as pain measures in children with cognitive impairment (CI). This study evaluated the validity and reliability of the revised and individualized Face Legs Activity Cry and Consolability (FLACC) behavioral pain assessment tool in children with CI.
Children with CI scheduled for elective surgery were studied. The FLACC was revised to include specific descriptors and parent-identified, unique behaviors for individual children. The child's ability to self-report pain was evaluated. Postoperatively, two nurses scored pain using the revised FLACC scale before and after analgesic administration, and, children self-reported a pain score, if able. Observations were videotaped and later viewed by experienced nurses blinded to analgesic administration.
Eighty observations were recorded in 52 children aged 4-19 years. Twenty-one parents added individualized pain behaviors to the revised FLACC. Interrater reliability was supported by excellent intraclass correlation coefficients (ICC, ranging from 0.76 to 0.90) and adequate kappa statistics (0.44-0.57). Criterion validity was supported by the correlations between FLACC, parent, and child scores (rho = 0.65-0.87; P < 0.001). Construct validity was demonstrated by the decrease in FLACC scores following analgesic administration (6.1 +/- 2.6 vs 1.9 +/- 2.7; P < 0.001).
Findings support the reliability and validity of the FLACC as a measure of pain in children with CI.
对于无法自我报告疼痛的个体，疼痛评估存在困难，这对有效的疼痛管理构成了重大障碍。然而，现有的评估工具在认知障碍（CI）儿童中作为疼痛测量方法缺乏一致的可靠性。本研究评估了修订后的个性化面部、腿部、活动、哭闹及可安慰性（FLACC）行为疼痛评估工具在CI儿童中的有效性和可靠性。
对计划进行择期手术的CI儿童进行研究。对FLACC进行了修订，纳入了特定描述以及家长确定的每个儿童独特的行为。评估了儿童自我报告疼痛的能力。术后，两名护士在给予镇痛药前后使用修订后的FLACC量表对疼痛进行评分，若儿童能够自我报告，则让其报告疼痛评分。观察过程进行录像，之后由对镇痛药使用情况不知情的经验丰富的护士观看。
对52名4至19岁儿童进行了80次观察。21名家长为修订后的FLACC添加了个性化疼痛行为。组内相关系数（ICC，范围为0.76至0.90）良好以及kappa统计量充足（0.44 - 0.57）支持了评分者间信度。FLACC、家长和儿童评分之间的相关性（rho = 0.65 - 0.87；P < 0.001）支持了效标效度。镇痛药给药后FLACC评分降低（6.1 ± 2.6对1.9 ± 2.7；P < 0.001）证明了结构效度。
研究结果支持FLACC作为CI儿童疼痛测量方法的可靠性和有效性。
