The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment

Malviya, Shobha; Voepel‐Lewis, Terri; Burke, Constance; Merkel, Sandra; Tait, Alan R.

doi:10.1111/j.1460-9592.2005.01773.x

Cited by 426 publications

(281 citation statements)

References 33 publications

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“…As evaluated by Malviya S et al, the FLACC scale can be individualized for use in children with altered cognitive states. 12 Nilsson S et al showed that FLACC scale is adequate for children between 5 and 16 years of age. 14 Voepel-Lewis T et al validated the use of FLACC in intensive care units, with a good correlation with numeric 0-10 scales.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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“…23,24 To address this, the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (Ped-IMMPACT) group has called for "specific planning and co-ordination" for communicating with non-verbal and/or cognitively impaired children. 25,26 The revised FLACC observational tool has been studied and found to be reliable and valid in children with cognitive impairment in some settings, and while challenging to apply in the ED, may provide a starting point for development of a tool in this environment. This underscores the importance of directing educational initiatives for residents on the assessment of pain in non-verbal, developmentally disabled children.…”

Section: Discussionmentioning

confidence: 99%

Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

Ali

Kircher

Meyers

et al. 2015

CJEM

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Background: Under-treatment of children's pain in the emergency department (ED) can have many detrimental effects. Emergency medicine (EM) residents often manage pediatric pain, but their educational needs and perspectives have not been studied. Methods: A novel online survey was administered from May to June 2013 to 122 EM residents at three Canadian universities using a modified Dillman methodology. The survey instrument captured information on training received in pediatric acute pain management, approach to common painful presentations, level of comfort, perceived facilitators, and barriers and attitudes towards pediatric pain. Results: 56 residents participated (46%), 25 of whom (45%) indicated they had not received any training in pediatric pain assessment. All levels of residents reported they were uncomfortable with pain assessment in 0-2 year olds (p = 0.07); level of comfort with assessment increased with years of training for patients aged 2-12 years (p = 0.02). When assessing children with disabilities, 83% of respondents (45/54) indicated they were 'extremely' or 'somewhat' uncomfortable. Sixty-nine percent (38/55) had received training on how to treat pediatric pain. All residents reported they were more comfortable using pain medication for a 9 year old, as compared to a 1 year old (oral oxycodone p < 0.001, oral morphine p < 0.001, IV morphine p = 0.004). The preferred methods to learn about children's pain management were role-modeling (61%) and lectures (57%). The top challenges in pain management were with non-verbal, younger, or developmentally delayed patients. Conclusion: Canadian EM residents report receiving inadequate training in pediatric pain management, and are particularly uneasy with younger or developmentally disabled children. Post-graduate curricula should be adjusted to correct these self-identified weaknesses in children's pain management.

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“…For example, the next iteration of the OUCH card will include the revised Face, Leg, Activity, Cry, Consolability Scale observational pain tool, which shows improved reliability and validity for pain assessment in children with cognitive impairment. 39 Finally, determining best practices for the most efficient and cost-effective means of delivering pain management education is a greatly needed step 40 that may be discernible in subsequent studies. The effect of lecture versus OUCH card distribution (as well as their combination) merits further investigation in order to better understand the optimal content and format of training programs.…”

Section: Discussionmentioning

confidence: 99%

Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

Saroyan¹,

Schechter²,

Tresgallo³

et al. 2010

Journal of Graduate Medical Education

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There are unique concerns for residents and fellows treating hospitalized children in pain. Some children cannot necessarily communicate their pain, 1,2 and the dosages for children differ dramatically by age and weight.3 Finally, because of a fear of adverse effects, the undertreatment of pain (ie, giving too little medicine) has been reported. 4,5 Lapses in the treatment of children's pain have been attributed, in part, to the following: systematic and logistical barriers within institutions providing pediatric care, 6 knowledge-based barriers including insufficient knowledge of pain assessment and treatment in children, 7 and inadequate pediatric pain management (PPM) educational requirements for residency programs.8 These inadequacies have also been shown to be widespread across a variety of pediatric settings such as cardiac surgery, AbstractBackground There are well-established deficiencies in residents' knowledge of acute-pain assessment and treatment in hospitalized children.

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The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment

Abstract: Findings support the reliability and validity of the FLACC as a measure of pain in children with CI.

Cited by 426 publications

References 33 publications

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

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

Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

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