title: Development and validation of a pictorial nausea rating scale for children.
abstract: OBJECTIVE
  The lack of a widely used, validated measure limits pediatric nausea management. The goal of this study was to create and validate a pictorial scale with regular incremental levels between scores depicting increasing nausea intensity.
  
  
  METHODS
  A pictorial nausea scale of 0 to 10 with 6 faces (the Baxter Retching Faces [BARF] scale) was developed in 3 stages. The BARF scale was validated in emergency department patients with vomiting and in healthy patients undergoing day surgery procedures. Patients were presented with visual analog scales for nausea and pain, the pictorial Faces Pain Scale-Revised, and the BARF scale. Patients receiving opioid analgesics or antiemetic agents had their pain and nausea assessed before and 30 minutes after therapy. Spearman's ρ correlation coefficients were calculated. A Wilcoxon matched-pair rank test compared pain and nausea scores before and after antiemetic therapy.
  
  
  RESULTS
  Thirty oncology patients and 15 nurses participated in the development of the scale, and 127 patients (52, emergency department; 75, day surgery) ages 7 to 18 years participated in the validation. The Spearman ρ correlation coefficient of the first paired BARF and visual analog scale for nausea scores was 0.93. Visual analog scales for nausea and BARF scores were significantly higher in patients requiring antiemetic agents (P = .0001) and decreased significantly after treatment (P = .0002), while posttreatment VAS (P = .20) and FPSR scores (P =.47) for patients receiving only antiemetic agents did not [corrected].
  
  
  CONCLUSIONS
  We describe the development of a pictorial scale with beginning evidence of construct validity for a self-report assessment of the severity of pediatric nausea. The scale had convergent and discriminant validity, along with an ability to detect change after treatment.
authors.affiliation: Medical College of Georgia, Pediatric Emergency Medicine Associates, Atlanta, Georgia, USA. amy_baxter@PEMA-LLC.com
authors.forename: Amy L
authors.initials: AL
authors.lastname: Baxter
authors.forename: Mehernoor F
authors.initials: MF
authors.lastname: Watcha
authors.forename: William Valentine
authors.initials: WV
authors.lastname: Baxter
authors.forename: Traci
authors.initials: T
authors.lastname: Leong
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Wyatt
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000145:classification / Q000175:diagnosis*; D009369:Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires