Pain assessment in paediatrics : a comparison of self-report and observational scales

Abstract

Pain assessment in paediatrics: A comparison of self-report and observational scales. The assessment of pain in children and adolescents can be carried out using self-report or observational measures. However, locally, guidelines for pain assessment in paediatrics have not yet been developed. The proposed PICO question for this literature review is: "In children and adolescents with pain (P), are self-report rating scales (I) more effective than behavioural/ observational (C) scales when assessing pain (O)?" Hence, the aims of this dissertation are to: identify the best method of pain assessment; and provide a list of pain assessment scales that can be used in children and adolescents, aged 3-18 years, with or without cognitive impairment according to their respective age, cognitive ability, and clinical pain context. Following a thorough search of the literature, numerous studies, published between 2001 and 2011, that aimed to assess the reliability and validity of self-report and observational scales were retrieved. Eight studies comprising of four systematic reviews, one randomised controlled trial and three cohorts were critiqued using critical appraisal tools (CASP and STROBE). The main findings further support the use of self-report scales as a gold-standard of pain assessment secondary to the subjective nature of pain. The faces scales were consequently the most preferred measures in the population of interest. However, observational measures should be used in children younger than 4 years, and in those unable to self-report (children with cognitive impairment, and those who are sedated or ventilated). These findings encourage the local implementation of good-practice guidelines for the assessment of pain in paediatrics, through the use of valid and reliable self-report and observational scales. Additionally, the importance of the subject should be emphasised to both staff and student nurses alike.