Examining the validity,reliability, and preference of three pediatric pain measurement tools in African-American children

PURPOSE: To compare the validity, reliability, and preference of pain intensity measurement tools--the African-American Oucher Scale, the Wong-Baker FACES Scale, and the Visual Analog Scale (VAS)--in 100 African-American children between 3 and 18 years of age. METHODS: During a visit to the sickle cell anemia clinic, the children were asked to describe two painful procedures/treatments they had experienced and to choose which one hurt the most. They rated the pain intensity of each procedure/treatment on the three scales that were presented in a preselected order. After using all the scales, the children then chose their favorite scale. The same procedure was repeated at the end of the visit, with a minimum of 15 minutes between the test and retest. RESULTS: Concurrent validity was determined by comparing the rank order of the two identified painful items with the pain scores on the three scales. Chi square analysis indicated a statistically significant difference among the scales for preference (chi2 = 24.08, df = 2, p < 0.0001) and reliability (chi2 = 6.12, df = 2, p < 0.05), but not validity (chi2 = 0.81, df = 2, NS) for the entire sample. Most children preferred using the FACES Scale (56%) versus the Oucher (26%) and VAS (18%). When the data were analyzed for three cognitive stages (ages 3-7, 8-12, and 13-18 years), the following were found: For the school-age period, chi square for reliability did not reach significance (chi2 = 4.35, df = 2, NS); for the preschool-age period, chi square for validity did reach significance (chi2 = 6.49, df = 2, p < 0.05) and was strongest for the FACES scale, followed by the Oucher. CONCLUSIONS: The study findings indicated that the FACES and African-American Oucher Scales are valid and reliable tools for measuring pain in children. Among the entire sample and each age group, the FACES scale was the most preferred scale.