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Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale

Le May, Sylviea,b,*; Ballard, Arianea,b; Khadra, Christellea,b; Gouin, Sergec; Plint, Amy C.d; Villeneuve, Edithe; Mâsse, Benoitb; Tsze, Daniel S.f; Neto, Ginag; Drendel, Amy L.h; Auclair, Marie-Christineb; McGrath, Patrick J.i; Ali, Saminaj,k

doi: 10.1097/j.pain.0000000000001236
Research Paper

Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED). The inclusion criteria were children aged 6 to 17 years presenting to the ED with a musculoskeletal injury and self-reported pain scores ≥30 mm on the mechanical Visual Analogue Scale (VAS). Self-reported pain intensity was assessed using the mechanical VAS, Faces Pain Scale-Revised (FPS-R), and Colour Analogue Scale (CAS). Convergent validity was assessed by Pearson correlations and the Bland–Altman method; responsiveness to change was assessed using paired sample t tests and standardized mean responses; and reliability was estimated using relative and absolute indices. A total of 456 participants were included, with a mean age of 11.9 years ± 2.7 and a majority were boys (252/456, 55.3%). Correlations between each pair of scales were 0.78 (VAS/FPS-R), 0.92 (VAS/CAS), and 0.79 (CAS/FPS-R). Limits of agreement (95% confidence interval) were −3.77 to 2.33 (VAS/FPS-R), −1.74 to 1.75 (VAS/CAS), and −2.21 to 3.62 (CAS/FPS-R). Responsiveness to change was demonstrated by significant differences in mean pain scores among the scales (P < 0.0001). Intraclass correlation coefficient and coefficient of repeatability estimates suggested acceptable reliability for the 3 scales at, respectively, 0.79 and ±2.29 (VAS), 0.82 and ±2.07 (CAS), and 0.76 and ±2.82 (FPS-R). The scales demonstrated good psychometric properties for children with acute pain in the ED. The VAS and CAS showed a strong convergent validity, whereas FPS-R was not in agreement with the other scales.

Mechanical Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale have strong responsiveness and reliability. A strong agreement was found between Visual Analogue Scale and Colour Analogue Scale.

aFaculty of Nursing, University of Montreal, Montreal, QC, Canada

bCHU Sainte-Justine Research Centre, Montreal, QC, Canada

cDivision of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada

dDepartment of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

eDepartment of Anesthesia, CHU Sainte-Justine, Montreal, QC, Canada

fDepartment of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, United States

gEmergency Department, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada

hDepartment of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States

iIWK Health Centre, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada

jWomen and Children's Health Research Institute, Edmonton, AB, Canada

kDepartment of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

Corresponding author. Address: Faculty of Nursing, University of Montreal, P.O. Box 6128, Succursale Centre-Ville, Montreal, QC H3C 3J7, Canada. Tel.: 514-566-8892. E-mail address: (S. Le May).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received September 22, 2017

Received in revised form March 23, 2018

Accepted March 28, 2018

© 2018 International Association for the Study of Pain
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