Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients

Abstract

Background Few investigators have evaluated pain assessment tools in the critical care setting.Objective To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain.Methods Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children).Results For 73 observations, FLACC scores correlated highly with the other 2 scores (ρ = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and κ statistics, as well as intraclass correlation coefficients (0.67–0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach α was 0.882 when all items were included.Conclusions Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.

Nurses’ Knowledge and Attitudes towards Pain Management in Children Admitted in the Paediatric Department of Queen Elizabeth Central Hospital, Blantyre, Malawi

“…Pain assessment methods such as self-reports, for example Faces scale [10]; behaviour observation, for example the FLACC scale (Facial expression, Legs, Activity, Cry and Consolability) scale [11] and caregiver reports may be used. Once identified, several measures are used to treat pain.…”

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

“…14 Voepel-Lewis T et al validated the use of FLACC in intensive care units, with a good correlation with numeric 0-10 scales. 15 The scale was translated and validated for use in Portuguese language. 13 After the non-pharmacological measures have been adopted and the most adequate scale has evaluated the patients, we shall initiate the pharmacological treatment of pain.…”

“…4,9,10 Scales were developed and validated due to theses difficulties, and their use is now well established for the evaluation and intervention on pediatric pain. [9][10][11][12][13][14][15][16][17][18] The implementation of scales has already shown to be plausible and effective on intensive care units, both adult and pediatric. Mansouri P et al demonstrated a decrease of 3 days in ICU stay with the use of protocols and scales for analgesia and sedation.…”

“…There is no clear literature recommendation on the frequency on which these scales should be applied, which depends on the therapeutic goals and the clinical state of the patient. 4,[10][11][12][13][14][15][16]23 Merkel SI et al created the FLACC scale in 1997, for children aged from 2 months to 7 years in a post-surgical setting. 19 The name FLACC is an acronym of five categories: Face, Legs, Activity, Cry, Consolability.…”

Efficacy of Caudal Ketamine with Different Concentrations of Levobupivacaine for Postoperative Analgesia in Paediatric Subumblical Surgeries

“…After extubation, patients were taken to recovery room; the postoperative pain was evaluated by FLACC Scale [13] for pain assessment in children (Face, Legs, Activity, Crying and Consolability), each given a score of 0-2 and the total score is from 0 to 10 at 0 h, 4 h, 8 h and 24 h postoperative. Also duration of analgesia and time to first spontaneous leg movement in both groups were monitored.…”