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Purpose:
To test the validity of the Faces, Legs, Activity, Cry and Consolability (FLACC) pain assessment tool by measuring changes in scores in response to analgesics.
Method:
Pediatric nurses used the FLACC scale to assess pain in 147 children under 3 years of age who were hospitalized in the pediatric intensive care unit (PICU), post-anesthesia care unit (PACU), surgical/trauma unit, hematology/oncology unit, or infant unit. FLACC is an observational tool for quantifying pain behaviors. Facial expression, leg movement, activity, cry, and consolability are each scored 0-2, for a total FLACC score of 0-10. The FLACC measurements were done pre-analgesia, at predicted onset of analgesia, and at predicted peak analgesia.
Findings:
Pre-analgesia FLACC scores were significantly higher than post-analgesic scores and significantly higher for patients who received opioids than patients who received non-opioids. Peak analgesia FLACC scores across analgesia groups were not significantly different and reflect effective pain relief for patients regardless of analgesic choice.
Conclusions:
The FLACC pain assessment tool is appropriate for preverbal children in pain from surgery, trauma, cancer, or other disease processes. The results support pediatric nurses' clinical judgment to determine analgesic choice rather than providing distinct FLACC scores to guide analgesic selection.
Pain has been defined as "whatever the experiencing person says it is, existing whenever the experiencing person says it does" (McCaffery, 1968). This definition illustrates the difficulty pediatric nurses face in identifying and quantifying pain behaviors in preverbal children. Preverbal patients cannot communicate their pain in the standard, subjective manner. This inability to express and quantify their pain places preverbal children at risk for inconsistent identification of pain and inadequate pain relief.
Pain is defined by the International Association for the Study of Pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage" (1979). This definition suggests that pain should be suspected in conditions or diseases that may cause pain regardless of the patient's ability to communicate their pain experience. The Agency for Health Care Policy and Research (AHCPR) clinical practice guidelines recommend a trial of analgesia to preverbal patients that clinicians suspect may be in pain (1992). The AHCPR's recommendation to act on a clinician's suspicion of pain...