title: Validation of the COMFORT Behavior scale and the FLACC scale for pain assessment in Chinese children after cardiac surgery.
abstract: Appropriate pain assessment plays a key role in understanding the pain status of critically ill children. However, the utility of the face, legs, activity, cry, consolability (FLACC) scale and the COMFORT Behavior (COMFORT-B) scale have not been extensively explored for children after cardiac surgery in China. A repeated-observation study was conducted to evaluate the concurrent validity and the sensitivity and specificity of the COMFORT-B and FLACC scales for pain assessment after cardiac surgery in 0-7-year-old patients. Patients were assessed with the observational visual analog scale (VASobs), FLACC scale, and COMFORT-B scale simultaneously at 18 fixed time periods for 3 days. Correlations among pain assessments were computed to calculate concurrent validity. Receiver operating characteristic curve analyses identified the FLACC and COMFORT-B scores that could best discriminate pain and no pain based on the VASobs. Multiple regression analyses were performed with FLACC and COMFORT-B pain scores as dependent variables and disease-related treatment characteristics as predictor variables for conducting the analysis. A total of 170 children (98 boys and 72 girls) were included. Significantly positive correlations, ranging from 0.31 to 0.86, were found among the COMFORT-B, FLACC, and VASobs pain assessment instruments. The COMFORT-B and the FLACC scores for children assessed to be in pain (i.e., VASobs ≥4), were significantly higher than scores for children not in pain (VASobs <4). COMFORT-B showed good sensitivity (86%) and specificity (83%) with a cutoff point of 13. FLACC showed excellent sensitivity (98%) and good specificity (88%) for a cutoff point of 2. The COMFORT-B and FLACC scales seem to be useful tools in pain assessment for Chinese children at postcardiac surgery stages, but the study identified that this group of children demonstrated a lower cutoff point for pain than originally set for these two instruments.
authors.affiliation: School of Nursing, Tianjin Medical University, Tianjin, China.
authors.forename: Jinbing
authors.initials: J
authors.lastname: Bai
authors.forename: Lily
authors.initials: L
authors.lastname: Hsu
authors.forename: Yan
authors.initials: Y
authors.lastname: Tang
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D002681:China; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009633:Nonverbal Communication; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing; D010149:Postoperative Pain / Q000175:diagnosis* / Q000451:nursing / Q000517:prevention & control; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity