Validation and reliability testing of FLACC behavioral pain assessment scale in Filipino postoperative pediatric patients

ABSTRACT

Background:The FLACC (Facial expression, Leg movement, Activity, Cry, Consalability) behavioral pain assessment scale was developed and validated by Merkel and colleagues among American children last 1997 for autepain assessment of children 2 months to 7 years of age. Since then, it has been validated among other nationalities. It is now being used in Scotland, Australia, Canada and Thailland. This study aimed to determine the inter-reter reliability and construct validity of the FLACC on Filipino posoperative pediatric patients. Methods: A total of 106 children less than 5 years of age (1,68+1.46 years) who were admitted in the Philippine General Hospital Post Anesthesia Care Unit (PACU) were included. Those who are operated on an emergency basis, had neurologic impairment, had developmental delay and required menchanical ventilation postoperatively were excluded. Prior to the data collection phase, the PACU nurses were trained to use the FLACC scale using videotapes of postoperative children. Whenever possible, children were silmultaneuosly rated by two idependent ratersdurig their stay in the PACU. Those with FLACC scores>4 were given an intervention and the pain measurement was repeated and reported accordingly. Results: Inter-rater reliability was good to very good with kappa values for the pain behavior items ranging from 0.75 to 0.82. Construct validity ws established by showing a statistically significant reduction (p<0.001) beteen the pre-intervention score and post-intervention score using Wilcoxon signed rank test. Conclusion: The FLACC exhibited bith inter-rater reliability and contruct validity in the measurement of acute postoperative pain in Filipino children less than 5 years old.