title: Discordance between patient self-reported visual analog scale pain scores and observed pain-related behavior in older children after surgery.
abstract: OBJECTIVE
  To assess the correlation in an older pediatric population between patient self-reported visual analog scale (VAS) pain scores and observational pain-related behavior scores.
  
  
  METHODS
  Prospective, comparative study.
  
  
  METHODS
  Inpatient surgical units of a free-standing children's hospital.
  
  
  METHODS
  30 ASA physical status I and II outpatients, 8 to 16 years of age, undergoing a variety of orthopedic, plastic, urologic, and general surgical procedures.
  
  
  METHODS
  Each patient underwent a single assessment of pain intensity on the first postoperative day.
  
  
  RESULTS
  Three health care providers (a clinical nurse specialist, a registered nurse with extensive pediatric experience, and a child life specialist) simultaneously generated an independent pain-related behavioral score (range of 0 = no pain to 100 = worst pain possible) based on their subjective perceptions of the patient's observed facial expression, activity level, and breathing pattern. The patient was then asked to provide a self-reported VAS pain score (range of 0 = "no pain" with a smiling face, to 100 = "worst pain ever" with a frowning face). A single set of such concurrent pain scores was obtained once from each study patient. The pain-related behavior scores displayed a satisfactory interrater reliability, with an observed interclass correlation coefficient (Cohen's kappa value) of 0.83. When compared with a patient's self-reported VAS score, the three pain related behavioral scores generated by each health care provider for a given patient exhibited both variable and minimal correlation.
  
  
  CONCLUSIONS
  A tenuous relationship may exist between on older child's own perception of pain intensity and his or her behavioral expression of that pain as interpreted by a health care provider.
authors.affiliation: Department of Anesthesiology, Children's Hospital Medical Center of Akron, OH 44308, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Vetter
authors.forename: E J
authors.initials: EJ
authors.lastname: Heiner
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D002652:Child Behavior; D005149:Facial Expression; D006801:Humans; D009720:Nurse Clinicians; D015588:Observer Variation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000451:nursing / Q000503:physiopathology / Q000523:psychology; D010371:Pediatric Nursing; D011446:Prospective Studies; D015203:Reproducibility of Results; D012119:Respiration; D012649:Self Concept; D012647:Self-Assessment