title: Inter-rater agreement and reliability of the COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) Checklist Cross-validation of a self-report scale for postoperative pain in school-aged children. Validation of 2 pain scales for use in the pediatric emergency department. Criterion and Convergent Validity for 4 Measures of Pain in a Pediatric Sickle Cell Disease Population Validity of Simplified Versus Standard Self-Report Measures of Pain Intensity in Preschool-Aged Children Undergoing Venipuncture. Do 0–10 Numeric Rating Scores Translate into Clinically Meaningful Pain Measures for Children? Clinically significant changes in acute pain in a pediatric ED using the Color Analog Scale. Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Postoperative self-report of pain in children: interscale agreement, response to analgesic, and preference for a faces scale and a visual analogue scale. Pain in 4- to 6-year-old children receiving intramuscular injections: a comparison of the Faces Pain Scale with other self-report and behavioral measures. Validation of Self-Report Pain Scales in Children An intrusive impact of anchors in children's faces pain scales Clinically significant differences in acute pain measured on self-report pain scales in children. Children's ratings of the intensity and unpleasantness of post-operative pain using facial expression scales. Developmental data supporting simplification of self-report pain scales for preschool-age children. Validation and properties of the verbal numeric scale in children with acute pain Assessment of clinically significant changes in acute pain in children. Using a worst pain intensity measure in children and adolescents Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale–Revised and Color Analog Scale in Children With Acute Pain The Wong-Baker Pain FACES Scale Measures Pain, Not Fear Simple pain rating scales hide complex idiosyncratic meanings Discordance between self-report and behavioral pain measures in children aged 3-7 years after surgery. Comparison of two pain scales in indian children A new analogue scale for assessing children's pain: an initial validation study Determining the minimum clinically significant difference in visual analog pain score for children. Reliability of the visual analog scale in children with acute pain in the emergency department A comparison of faces scales for the measurement of pediatric pain: children's and parents’ ratings Clinical utility of PPPM and FPS-R to quantify post-tonsillectomy pain in children. Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department. Variability of “optimal” cut points for mild, moderate, and severe pain: Neglected problems when comparing groups The faces pain scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and preliminary investigation for ratio scale properties Reliability of the color analog scale: repeatability of scores in traumatic and nontraumatic injuries.
abstract: Background The COSMIN checklist is a tool for evaluating the method ological quality of studies on measurement properties of health-related patient-reported outcomes . The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist ( n = 114 ) . Methods 75 articles evaluating measurement properties were r and omly selected from the bibliographic data base compiled by the Patient-Reported Outcome Measurement Group , Oxford , UK . Raters were asked to assess the method ological quality of three articles , using the COSMIN checklist . In a one-way design , percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item . Results 88 raters participated . Of the 75 selected articles , 26 articles were rated by four to six participants , and 49 by two or three participants . Overall , percentage agreement was appropriate ( 68 % was above 80 % agreement ) , and the kappa coefficients for the COSMIN items were low ( 61 % was below 0.40 , 6 % was above 0.75 ) . Reasons for low inter-rater agreement were need for subjective judgement , and accustom to different st and ards , terminology and definitions . Conclusions Results indicated that raters often choose the same response option , but that it is difficult on item level to distinguish between articles . When using the COSMIN checklist in a systematic review , we recommend getting some training and experience , completing it by two independent raters , and reaching consensus on one final rating . Instructions for using the checklist are improved The present study cross-vali date d self-report pain scales : Verbal Rating Scale ( VRS  ) ,  Facial Expression Scale ( FACES  ) ,  Color Analogue Scale ( CAS ) and Poker Chip Tool ( PCT ) in Thai children aged 5 - 12 years . The concordance with observational measure , Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) was also tested . Among 100 students , test-retest reliability of all self-report measures was moderate to good ( K = 0.501 - 0.712 ) and only FACES yielded acceptable face validity(IC > 0.5 ) . Validation in 87 patients , all scales showed construct and concurrent validity . FACES was the most preferred scale . Agreement of self-report measures and CHEOPS was better in the age group 5 - 8 years ( K = 0.417 - 0.826 ) than 9 - 12 years ( K = 0.231 - 0.529 ) . In conclusion , FACES is a valid , reliable and practical tool . Self-report measures are more in concordance with CHEOPS in the younger age group OBJECTIVE To determine the construct , content , and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department ( ED ) . METHODS A prospect i ve study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained . Children were excluded if they were intoxicated , had altered sensorium , were clinical ly unstable , did not speak English , or had developmental delays . Children marked their current pain severity on a st and ardized Color Analog Scale ( CAS ) and a 7-point Faces Pain Scale ( FPS ) . They were then asked whether their pain was mild , moderate , or severe . Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements . For assessing content validity , the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions . Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales . RESULTS A total of 60 children were enrolled , 30 with pain and 30 without , with a mean age of 9.3 + /- 3.3 years . Boys accounted for 38 of the enrollees ( 63.3 % ) . The median score before analgesic administration was 6.0 cm ( interquartile range [ IQR ] : 4.0 - 8.0 ) on the CAS and 3.0 faces ( IQR : 2.0 - 5.0 ) on the FPS ; after analgesic administration , the median scores decreased to 3.1 cm ( IQR : 1.1 - 4.3 ) and 2.0 faces ( IQR : 1.0 - 3.0 ) , respectively . As the reported pain intensity increased , so did the scores on the 2 pain scales . The 30 children with no pain had a median score on the CAS of 0.0 ( IQR : 0.0 - 1.0 ) and on the FPS of 0.0 ( IQR : 0.0 - 1.0 ) , whereas the 13 children with severe pain had a median CAS of 7.0 ( IQR : 6.0 - 8.0 ) and a median FPS of 5.0 ( IQR : 4.0 - 6.0 ) . The Spearman correlation coefficient between the CAS and the FPS was positive and strong ( r = 0.894 ) . CONCLUSION The CAS and the FPS exhibit construct , content , and convergent validity in the measurement of acute pain in children in the ED Objective To evaluate the psychometric properties of 4 measures of acute pain in youth with sickle cell disease ( SCD ) during a medical procedure . Methods Heart rate , child self-report , parent proxy-report , and observable pain behaviors were examined in 48 youth with SCD ages 2 to 17 years . Criterion validity for acute pain was assessed by responsiveness to a st and ardized painful stimulus ( venipuncture ) in a prospect i ve pre-post design . Convergent validity was evaluated through the correlation across measures in reactivity to the stimulus . Results Child self-reported pain , parent proxy-report , and behavioral distress scores increased in response to venipuncture ( concurrent and convergent validity ) . In contrast , heart rate did not reliably change in response to venipuncture . Extent of change in response to venipuncture showed moderate intercorrelation across child and parent pain ratings , and behavioral distress . Preprocedure pain ratings correlated with pain experienced during the procedure . An item analysis of observable pain behaviors suggested differences in the presentation of pain in SCD compared with previous pediatric research . Conclusions Criterion and convergent validity were demonstrated for child-report , parent-report , and observable pain behaviors . These measures seem to tap into distinct , yet overlapping aspects of the pain experience . Assessment of acute procedural pain responses in SCD requires evaluation of preprocedural pain due to the frequent presence of low-level , baseline pain There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children . Most preschool-aged children also lack the necessary cognitive development to use st and ard scales . We aim ed to evaluate the validity and feasibility of 2 novel simplified scales ( Simplified Faces Pain Scale , S-FPS ; Simplified Concrete Ordinal Scale , S-COS ) for preschool-aged children . These simplified scales used a 2-step self-report method : children were first asked whether they have pain ( yes/no ) ; only if yes , then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe . We recruited 180 3- to 6-year-old children undergoing routine blood collection . Each child was r and omly assigned 2 of 3 scales-S-FPS , S-COS , Faces Pain Scale-Revised (FPS-R)-to self-report pain before venipuncture , immediately after , and 5 minutes later , using both scales at each time-point . Pain was also assessed using observation ( Face Legs Activity Cry Consolability ) at each time point . The ability to discriminate pain from no pain was improved with S-FPS and S-COS , compared with the FPS-R , among 4-year-olds , but not 3-year-olds . Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales . The simplified scales can improve and simplify pain assessment for 4-year-olds . Quantitative pain rating remains challenging for 3-year-olds . PERSPECTIVE This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling . These scales demonstrated good validity and feasibility compared with the FPS-R , suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years BACKGROUND : Self-reported pain scores are used widely in clinical and research setting s , yet little is known about their interpretability in children . In this prospect i ve , observational study we evaluated the relationship between 0 to 10 numerical rating scale ( NRS ) pain scores and other self-reported , clinical ly meaningful outcomes , including perceived need for medicine ( PNM ) , pain relief ( PR ) , and perceived satisfaction ( PS ) with treatment in children postoperatively . METHODS : This study included children ages 7 to 16 years undergoing surgery associated with postoperative pain . One to 4 observations were recorded in each child within the first 24 hours postoperatively . At each assessment , children rated their pain with the NRS , stated their PNM , and rated their satisfaction with  pain management .  Assessment s were repeated within 1 to 2 hours , and children additionally rated their PR as the same , better , or worse in comparison with the earlier assessment . Receiver operator characteristic curves were developed to examine potential NRS cut-points for PNM and PS , and the minimum clinical ly significant difference ( MCSD ) in pain score associated with PR was calculated . RESULTS : Three hundred ninety-seven observations ( including 189 pairs ) were recorded in 113 children .  NRS scores associated with PNM were significantly higher than “ no need ” ( median 6 vs. 3 ; P < 0.001 ) . NRS scores > 4 had good sensitivity ( 0.81 ) and specificity ( 0.70 ) to discriminate PNM , but with a large number of false positives and negatives ( e.g. , 42 % of children with scores > 4 did not need analgesia ) . The MCSD in NRS scores was −1 ( 95 % confidence interval [ CI ] −0.5 to 1 ) or + 1 ( CI 0.5 to 2.7 ) in relation to feel “ a little better ” or “ worse , ” respectively ( P < 0.001 vs. the same ) . NRS scores > 6 had a sensitivity of 0.82 and specificity of 0.76 in discriminating dissatisfaction with treatment , yet 46 % and 24 % of children with scores > 6 , respectively , were somewhat to very satisfied with their analgesia . CONCLUSIONS : This study provides important information regarding the clinical interpretation of NRS pain scores in children . Data further support the NRS as a valid measure of pain intensity in relation to the child 's PNM , PR , and PS in the acute postoperative setting . However , the variability in scores in relation to other clinical ly meaningful outcomes suggests that application of cut-points for individual treatment decisions is inappropriate OBJECTIVE The purpose of this study is to quantify , using the  Color Analog Scale ( CAS ) , the degree of change in pain severity required to achieve a clinical ly significant improvement in pain . METHODS A prospect i ve descriptive study , using convenience sampling of children aged 5 and 12 years presenting to a pediatric emergency department ( ED ) with acute pain , was done . Children were asked to mark their pain severity on a previously vali date d CAS . After a pain intervention , the child was again asked to mark their pain intensity on the CAS and asked to describe the relative change in their pain . The main outcome measure was to quantify the smallest change required for the child to state that their pain was improved . RESULTS One hundred twenty-six children with a mean age of 8.6 years ( SD , 2.8 years ) were enrolled . Males accounted for 56 % . Pain was traumatic in 47.6 % and nontraumatic in 52.4 % . Of the 126 pain comparisons made , 28 children described their pain as " the same " and had a mean change in score of -0.10 cm ( 95 % confidence interval [ CI ] , -2.27 to 2.07 cm ) . Pain was judged to be a " little less " in 58 children , and the CAS score changed by a mean of -2.4 cm ( 95 % CI , -3.15 to -1.72 cm ) . In the 29 children who judged their pain to be " much less , " the CAS score decreased by a mean of -5.4 cm ( 95 % CI , -6.50 to -4.40 ) . CONCLUSION A decrease on the CAS pain scale of 2.4 cm ( 95 % CI , 2.95 - 1.92 ) is a clinical ly significant change in pain for children aged 5 to 12 years with acute pain . The CAS is a valuable tool in assessing responses to pain interventions OBJECTIVES The Wong-Baker FACES Pain Rating Scale ( WBS ) , used in children to rate pain severity , has been vali date d outside the emergency department ( ED ) , mostly for chronic pain . The authors vali date d the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale ( VAS ) for each face of the WBS and determined the relationship between the WBS and VAS . The hypothesis was that the pain severity ratings on the WBS would be highly correlated ( Spearman 's rho > 0.80 ) with those on a VAS . METHODS This was a prospect i ve , observational study of children ages 8 - 17 years with pain presenting to a suburban , academic pediatric ED . Children rated their pain severity on a six-item ordinal faces scale ( WBS ) from none to worst and a 100-mm VAS from least to most . Analysis of variance ( ANOVA ) was used to compare mean VAS scores across the six ordinal categories . Spearman 's correlation ( rho ) was used to measure agreement between the continuous and ordinal scales . RESULTS A total of 120 patients were assessed : the median age was 13 years ( interquartile range [ IQR ] = 10 - 15 years ) , 50 % were female , 78 % were white , and six patients ( 5 % ) used a language other than English at home . The most commonly specified locations of pain were extremity ( 37 % ) , abdomen ( 19 % ) , and back/neck ( 11 % ) . The mean VAS increased uniformly across WBS categories in increments of about 17 mm . ANOVA demonstrated significant differences in mean VAS across face groups . Post hoc testing demonstrated that each mean VAS was significantly different from every other mean VAS . Agreement between the WBS and VAS was excellent ( rho = 0.90 ; 95 % confidence interval [ CI ] = 0.86 to 0.93 ) . There was no association between age , sex , or pain location with either pain score . CONCLUSIONS The VAS was found to have an excellent correlation in older children with acute pain in the ED and had a uniformly increasing relationship with WBS . This finding has implication s for research on pain management using the WBS as an assessment tool OBJECTIVE To augment available validation data for the Faces Pain Scale - Revised ( FPS-R ) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale ( CAS ) in pediatric acute pain . METHOD The present prospect i ve , multicentre study included 131 in patients five to 15 years of age ( mean age 8.8 years ; 56 % male ) seen in postoperative recovery . They provided CAS and FPS-R pain scores before and after administration of analgesic medication . Nurses and physicians used the same tools as observational scales . Children and health care providers indicated which scale they preferred . RESULTS  FPS-R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups ( 0.66 < or= r < or= 0.88 ) . There were no significant mean differences in any age group between the scales . Scores on the two scales differed by 210 or less in 81 % to 91 % of children , depending on age . Both scales demonstrated expected changes in postoperative pain following administration of an analgesic . Scores at the upper end point were given by approximately 20 % of children five to six years of age on both scales , compared with 2 % to 9 % in the older age groups . Health care providers ' observational ratings were significantly lower than self-ratings . The FPS-R was preferred over the CAS by most children in all age groups and both sexes . Global satisfaction of the health care providers was similar for both tools . DISCUSSION These results support the use of the FPS-R for most children five years of age or older in the postoperative period . Further research is needed to identify young children , particularly those younger than seven years of age , who have difficulty with self-report tools , and to establish methods for training them in the reliable use of these measures OBJECTIVE The main objective was to compare the utility of the Faces Pain Scale  ( Bieri et al. , 1990 ) with three alternative self-report measures of pain intensity in children , as well as with pain ratings based on observations of the child 's behavior . DESIGN Fifty children used 4 self-report scales to rate the severity of needle pain from routine immunization . Using videotapes , the child 's pain-related behavior was coded in detailed fashion , and a subset of the sample were also rated globally by 60 registered pediatric nurses . MAIN OUTCOME MEASURES  Faces Pain Scale ; Poker Chip Tool ; Visual Analogue Toy ; Verbal Rating Scale ;  behavioral checklist ( scoring observable facial , motor , verbal and vocal reactions ) . RESULTS AND CONCLUSIONS The  Faces Pain Scale  was simple to use , readily understood by the children , and showed a realistic distribution of scores with respect to the type of pain being measured . With the exception of verbal reactions ( which were not meaningfully related to self-report ) , observer ratings based on detailed coding of the child 's behavior correlated only poorly to moderately well with self-report scores ( r = .39 to r = .58 ) . Similarly , although confident in their judgments , the nurses ' ratings showed only moderate agreement with those of the children . In estimating the child 's pain , all observers appeared to appropriately weigh changes in the child 's facial behavior , which showed evidence of being the most sensitive behavioral index to the intensity of short sharp ( needle ) pain in 4 to 6 years olds BACKGROUND AND OBJECTIVES : The Faces Pain Scale – Revised ( FPS-R ) and Color Analog Scale ( CAS ) are self-report pain scales commonly used in children but insufficiently vali date d in the emergency department setting . Our objectives were to determine the psychometric properties ( convergent validity , discriminative validity , responsivity , and reliability ) of the FPS-R and CAS , and to determine whether degree of validity varied based on age , sex , and ethnicity . METHODS : We conducted a prospect i ve , observational study of English- and Spanish-speaking children ages 4 to 17 years . Children with painful conditions indicated their pain severity on the FPS-R and CAS before and 30 minutes after analgesia . We assessed convergent validity ( Pearson correlations , Bl and -Altman method ) , discriminative validity ( comparing pain scores in children with pain against those without pain ) , responsivity ( comparing pain scores pre- and postanalgesia ) , and reliability ( Pearson correlations , repeatability coefficient ) . RESULTS : Of 620 patients analyzed , mean age was 9.2 ± 3.8 years , 291(46.8 % ) children were girls , 341(55 % ) were Hispanic , and 313(50.5 % ) were in the younger age group ( < 8 years ) . Pearson correlation was 0.85 , with higher correlation in older children and girls . Lower convergent validity was noted in children < 7 years of age . All subgroups based on age , sex , and ethnicity demonstrated discriminative validity and responsivity for both scales . Reliability was acceptable for both the FPS-R and CAS . CONCLUSIONS : The FPS-R and CAS overall demonstrate strong psychometric properties in children ages 4 to 17 years , and between subgroups based on age , sex , and ethnicity . Convergent validity was question able in children < 7 years old & NA ; The numerous pain rating scales using faces depicting varying degrees of distress to elicit reports of pain from children fall into two categories ; those with a neutral face as the ‘ no pain ’ anchor , and those with a smiling face as the ‘ no pain ’ anchor . This study examined the potentially biasing impact of these anchor types on children 's self‐reports  of pain  in response to a series of vignettes . Participants were 100 children stratified by age ( 5–6 years , 7–8 years , 9–12 years ) and r and omly assigned to one of three groups : ( 1 ) neutral scale/sensory instructions ; ( 2 ) smiling scale/sensory instructions ; ( 3 ) smiling scale/affective instructions . Children completed a  faces scale , a VAS , and emotions ratings  in response to four scenarios depicting : ( 1 ) no pain/negative emotions ; ( 2 ) pain/negative emotions ; ( 3 ) no pain/positive emotions ; ( 4 ) pain/positive emotions . Results showed that children who used the smiling scale had significantly higher pain scores for no pain and pain/negative emotions vignettes and significantly lower faces scale scores for pain/positive vignettes than children who used the neutral faces scale . Instructions varying in focus on sensory or affective qualities of pain had no effect on children 's pain ratings . Group differences in children 's ratings with the VAS and emotions measure suggested that rating pain with a smiling faces scale may alter a child 's concept of pain . Age differences indicated the younger children rated the negative emotion vignettes as more painful than the older children . These findings suggest that children 's pain ratings vary depending on the types of faces scale used , and that faces scales with smiling anchors may confound affective states with pain ratings OBJECTIVES The objective was to determine the minimum and ideal clinical ly significant differences ( MCSD , ICSD ) in  pain intensity in children for the Faces Pain Scale-Revised ( FPS-R ) and the Color Analog Scale ( CAS ) and to identify any differences in these estimates based on patient characteristics . METHODS This was a prospect i ve study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments . Participants self-reported their pain intensity using the FPS-R and CAS and qualitatively described their changes in pain . Changes in pain score reported using the FPS-R and CAS that were associated with " a little less " and " much less " pain ( MCSD and ICSD , respectively ) were identified using a receiver operating characteristic-based method and expressed as raw change score and percent reductions . Estimates of MCSD and ICSD were determined for each category of initial pain intensity ( mild , moderate , and severe ) and patient characteristics ( age , sex , and ethnicity ) . Post hoc exploratory analyses evaluated categories of race , primary language , and etiology of pain . RESULTS A total of 314 children with acute pain were enrolled ; mean ( ±SD ) age was 9.8 ( ±3.8 ) years . The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25 % , with ICSD estimates of 3/10 and 60 % . For the CAS , raw change score and percent reduction MCSD estimates were 1/10 and 15 % , with ICSD estimates of 2.75/10 and 52 % . For both scales , raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain . For both scales , estimates of ICSD were not stable across categories of initial pain intensity . There was no difference in MCSD or ICSD based on age , sex , ethnicity , race , primary language , or etiology of pain . CONCLUSIONS The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS . These estimates appear stable for children with moderate to severe pain , irrespective of age , sex , and ethnicity . Estimates of ICSD were not stable across different categories of initial pain intensity , therefore limiting their potential generalizability This study explored whether global unidimensional self-report pain scales based on facial expression help children separately estimate the sensory and affective magnitude of post-operative pain . Ninety paediatric elective surgery patients ( in two age groups : 5 - 9 and 10 - 15 years ) used each of four scales to estimate pain intensity and pain affect during the first 2 days after surgery . The four scales were :  Faces Pain Scale ( FPS ) , Facial Affective Scale ( FAS ) , and the Coloured Analogue Scale ( CAS )  ( one for intensity and one for unpleasantness ) . As hypothesised , ratings on the FPS correlated more highly with analogue scale ratings for intensity than for unpleasantness , whereas ratings on the FAS correlated more highly with those on the analogue scale for unpleasantness than for intensity . Factor analysis indicated that although all measures loaded on a single dimension of distress , there was an additional weaker factor corresponding to a unique contribution of the FAS . No systematic age effects were observed . It was concluded that the FPS and the FAS may partly measure different aspects of the postoperative pain experience in children , although shared instrument variance may obscure true estimates of covariation in ratings of intensity and affective magnitude . The clinical relevance of the present results remains to be determined UNLABELLED Cl aims regarding the ability of preschool-age children to provide accurate self-reports using st and ard pain scales are not well supported by age-specific evidence . Responses of children younger than 5 years are often idiosyncratic and subject to biases . Simplifying the task of self-report of pain would make it more developmentally appropriate for 3- to 5-year-olds . A binary question is asked : " Does it hurt ? " or an equivalent . If yes , a simplified scale is presented , comprising 3 categories representing low , medium , and high pain severity . Children aged 3 to 5 years ( N = 184 ) were recruited from preschools and day care centers . Following parental consent and child assent , children were r and omly assigned to use either the  Faces Pain Scale-Revised or a 3-face scale preceded by a yes-no question to rate pain in 9 picture stories from the Charleston Pediatric Pain Pictures portraying no pain , moderate pain , and severe pain . The  simplified pain rating task  made no difference for 5-year-olds , whose mean scores were nearly identical using the 2 approaches . However , discrimination of the 3 levels of Charleston Pediatric Pain Pictures items was significantly better in 3- and 4-year-olds with the simplified task than with the  Faces Pain Scale-Revised .  Simplifying the task improved preschool-age children 's ability to estimate pain intensity . PERSPECTIVE St and ard self-report pain scales with 6 faces are confusing for many 3- and 4-year-olds . In basic preparatory research for future development of a preschool self-report pain scale , we simplified the task . This simplification made no difference for 5-year-olds but improved the performance of 3- and 4-year-olds & NA ; Although the verbal numeric scale ( VNS ) is used frequently at patients ’ bedsides , it has never been formally vali date d in children with acute pain . In order to vali date this scale , a prospect i ve cohort study was performed in children between 8 and 17 years presenting to a pediatric emergency department ( ED ) with acute pain . Pain was grade d using the VNS , the visual analogue scale ( VAS ) , and the verbal rating scale ( VRS ) .  A second assessment was done before discharge . We determined a priori that in order to be valid , the VNS would need to : correlate with the VAS ( concurrent validity ) ; decrease after intervention to reduce pain ( construct validity ) ; and be associated with the VRS categories ( content validity ) . The VNS interchangeability with the VAS , its minimal clinical ly significant difference , and test – retest reliability were also determined . A total of 202 patients ( mean age : 12.2 ± 2.6 years ) were enrolled . The VNS correlated with the VAS : ric = 0.93 , p < 0.001 . There were differences in the VNS before versus after interventions ( p < 0.001 ) , and between VRS categories ( mild versus moderate , p < 0.001 ; moderate versus severe , p < 0.001 ) . The 95 % limits of agreement ( interchangeability ) between VNS/VAS were outside the a priori set limit of ±2.0 : −1.8 , 2.5 . The VNS minimal clinical ly significant difference was 1 . The VNS had good test – retest reliability with 95 % limits of agreement of −0.9 and 1.2 . In conclusion , the VNS  provides a valid and reliable scale to evaluate acute pain in children aged 8–17 years but is not interchangeable with the VAS OBJECTIVE To quantify , using two pain assessment scales , the amount of change in pain severity required to achieve a clinical ly significant improvement in pain in children presenting to a pediatric emergency department ( ED ) with pain . METHODS Prospect i ve , descriptive study involving all children presenting to a pediatric ED between 5 and 16 years of age inclusive with acute pain . Children were excluded if they 1 ) were intoxicated or had altered sensorium , 2 ) were clinical ly unstable , 3 ) were non-English-speaking , or 4 ) were developmentally delayed . Written informed consent was obtained . Children were asked to mark their current pain severity on the st and ardized Color Analogue Scale ( CAS ) and Faces Pain Scale ( FPS ) . After each pain control intervention the child was asked to repeat these measurements and to describe whether his or her pain was " much less , " " a little less , " " about the same , " " a little worse , " or " much worse " compared with before . This process was repeated until the child was discharged from the ED or had a score of zero . The main outcome measure was the smallest change on the CAS or FPS necessary to cause the child to describe his or her pain as a " little less . " This was defined as the clinical ly significant change in pain . The " ideal " change in pain was defined as the amount of change necessary for the child to describe the pain as " much less " or at which point the child thought he or she no longer required any medicine to help the pain go away . RESULTS One hundred twenty-one children were enrolled with a mean age of 9.8 years ( SD + /- 3.15 ) . Males accounted for 56 % . Pain was traumatic in 65 % and nontraumatic in 35 % . A total of 153 pain comparisons were made using the CAS and 154 using the FPS . Only three children complained that their pain got worse ( two a little worse and one much worse ) . Pain was described as " the same " in 20 . Of the 60 pain comparisons judged to be a " little less , " the CAS score changed by a median of 2.0 cm [ interquartile ratio ( IQR ) 1 - 3 ] , and the FPS by 1.0 face ( IQR 1 - 2 ) . In the 71 children who judged their pain to be " much less , " the CAS decreased by a median of 4.0 cm ( IQR 2 - 5 ) and the FPS by 2.0 faces ( IQR 2 - 3 ) . CONCLUSIONS The assessment and treatment of  pain in children are an important component of pediatric practice , especially in the ED . This study provides health care professionals and clinical investigators the information necessary to assess whether their method of pain control in children is clinical ly relevant AIMS To explore inconsistencies and the reliability in worst pain intensity ratings in children . BACKGROUND Asking for worst pain always requires a retrospective evaluation which is controversially discussed . DESIGN Retrospective analysis of registry data and a prospect i ve study . METHODS Retrospective study : 5970 patients [ age : 10·2(4·0 ) years , female : 41 % data collection : 2008 - 2015 ] ; Prospect i ve study : 240 patients [ age : 14·7(1·9 ) years , female : 43 % , data collection 2013 - 2014 ] were included . In both studies , the number of implausible pain intensity ratings was calculated ( both studies : worst pain lower than movement pain or pain at rest , prospect i ve study : number of patients reporting lower pain intensity ratings in worst pain items for the same time period in a second assessment ) . Test-retest reliability was calculated for the prospect i ve study . Changes in worst pain ratings were analyzed using Wilcoxon signed ranks test . RESULTS Test-retest reliability ranged from ρ = 0·77 - 0·90 . In the retrospective study , 8·9 % ( 95%CI : 8·2 - 9·6 % ) of our patients reported higher movement and /or pain at rest compared with worst pain . In the prospect i ve study , 35·8 % ( 95%CI : 30·0 - 42·1 % ) reported higher activity pain ratings compared with worst pain ratings in at least one pain assessment ; 13·8 % of the pediatric patients  reported lower pain intensity ratings in worst pain items in a second assessment compared with the first assessment . CONCLUSION Nine to 36 % of our patients showed inconsistent worst pain ratings . To overcome this problem , more specific pain intensity items , more than one item or a better instruction for pediatric patients could be used Objectives The aims of this study were to define the Faces Pain Scale – Revised ( FPS-R ) and Color Analog Scale ( CAS ) scores associated with no pain , mild pain , moderate pain , and severe pain in children with acute pain , and to identify differences based on age , sex , and ethnicity . Methods We conducted a prospect i ve observational study in 2 pediatric emergency departments of children aged 4 to 17 years with painful and nonpainful conditions . We assessed their pain intensity using the FPS-R , CAS , and qualitative measures .  Pain score cut points that best differentiated adjacent categories of pain were identified using a receiver operating characteristic – based method . Cut points were compared within subgroups based on age , sex , and ethnicity . Results We enrolled 620 patients , of whom 314 had painful conditions . The mean age was 9.2 years ; 315 ( 50.8 % ) were in the younger age group ( aged 4–7 years ) ; 291 ( 46.8 % ) were female ; and 341 ( 55 % ) were Hispanic . The scores best representing categories of pain for the FPS-R were as follows : no pain , 0 and 2 ; mild pain , 4 ; moderate pain , 6 ; and severe pain , 8 and 10 . For the CAS , these were 0 to 1 , 1.25 to 2.75 , 3 to 5.75 , and 6 to 10 , respectively . Children with no pain frequently reported nonzero pain scores . There was considerable overlap of scores associated with mild and moderate pain . There were no clinical ly meaningful differences of scores representing each category of pain based on age , ethnicity , and race . Conclusions We defined pain scores for the FPS-R and CAS associated with categories of pain intensity in children with acute pain that are generalizable across subgroups based on patient characteristics . There were minor but potentially important differences in pain scores used to delineate categories of pain intensity compared to prior convention Objective The Wong-Baker FACES Pain Rating Scale ( WBS ) is preferred by parents and patients for reporting pain severity . However , it is speculated that the “ no hurt ” and “ hurts worst ” anchors confound pain measurement with nonnociceptive states . The objective of our study was to determine if fear confounds reporting of pain severity on the WBS . We hypothesized that the WBS would correlate with a psychometrically different pain severity scale ( the visual analog scale [ VAS ] ) and not correlate with a fear measure , the Child Medical Fear Scale ( CMFS ) . Methods This was a prospect i ve observational study of children 7 to 12 years presenting to a university-based suburban pediatric ED with acute pain . Patients rated pain severity on the WBS ordinal scale and a 100-mm unhatched VAS with marked end points of “ no pain ” and “ worse pain ever . ” Patients also completed a 26-item CMFS . Correlations between the WBS and VAS with the CMFS total score were assessed with Spearman correlation and exploratory factor analysis . Results All 3 scales were completed in 197 children .  Correlation between the severity scales ( WBS-VAS ) was moderate : 0.63 ( 95 % confidence interval [ CI ] , 0.54–0.71 ) . However , correlations between the WBS-CMFS and VAS-CMFS were poor : −0.02 ( 95 % CI , −0.16 to −0.12 ) and 0.01 ( 95 % CI , −0.13 to 0.15 ) , respectively . Correlations did not differ by sex , grade , pain location , or cause of pain ( traumatic vs atraumatic ) . Exploratory factor analysis demonstrated excellent loadings within 2 factors : pain and fear . Conclusions The WBS demonstrates moderate correlation with another measure of pain ( VAS ) and is not mistaken for fear among school-aged patients presenting to the ED with pain & NA ; Assumptions of reliability and consistency of self‐report of pain by patients using visual analogue scales ( VAS ) and numerical rating scales ( NRS )  are based on narrow considerations of possible sources of error . This study examined patients ’ use of  VASs and NRSs  , by their own description , with particular attention to rating of multiple pains , of different dimensions of pain , and of interpretation and use of lower and upper endpoints and increments on the scales . These have implication s for the approximation of the scales to psychometric requirements . An interview developed from a small pilot project was given to 78 volunteer chronic pain patients embarking on a pain management course , and consisted of both forced choice questions and free response . Data are described with reference to lack of concordance between patients and of consistency within patients ; responses suggested that ratings incorporate multiple partially differentiated dimensions of pain , with particular importance placed on function or mobility . Labels assigned to scale endpoints by research ers , whether lexical or numerical , appeared to affect their use ; however , covert relabelling of scale points was revealed in free response . The action of arriving at a rating is better conceptualised as an attempt to construct meaning , influenced by and with reference to a range of internal and external factors and private meanings , rather than as a task of matching a distance or number to a discrete internal stimulus This study examined concurrent self-reports of pain intensity  and behavioral responses in 25 children aged 3 - 7 yr .  Behavioral (  Children 's Hospital of Eastern Ontario Pain Scale , CHEOPS ) and self-report ( the Oucher and Analogue Chromatic Continuous Scale ) measures of pain were obtained following major surgery . The two self-report measures were strongly and significantly correlated , and the pattern of scores over the 36-hr observation period was as expected . There was little relationship between the scores for the self-report and the behavioral measures . Many children who reported severe pain manifested few of the behavioral indicators of distress used in the CHEOPS . This behavioral response pattern may occur commonly in children experiencing pain after surgery and may limit the applicability of current behavioral scales as sole measures of pain intensity in younger children Objective . To compare the Faces Pain Scale and Color Analogue Scale among children aged 6–12 years undergoing selected procedures ( Venipuncture , Intravenous cannulation , Intramuscular injection , Lumbar puncture , Bone marrow aspiration )  and to compare the procedural pain in a child as perceived by the child , parents and health care professionals using the above mentioned scales Methods . This was a prospect i ve , descriptive correlational study of children aged 6–12 years , who had undergone selected procedures . Children were assessed for their pain severity using  Faces Pain Scale and Color Analogue Scale .  Parents and health care professionals also independently assessed the child 's pain using the same scales Results . 181 children who fulfilled the eligibility criteria were enrolled in the study . There was a significant positive correlation ( r = > 0.8 ) between both the pain scales . There was fair to moderate positive correlation ( r = 0.29 to 0.58 ) of pain perception of child with parents and health care professionals Conclusions . Faces Pain Scale and Color Analogue Scales seem to be appropriate instruments for measuring pain intensity among Indian children aged 6–12 years undergoing selected & NA ; A new instrument was design ed to provide a practical clinical measure for assessing children 's pain intensity and pain affect .  The pocket size measure includes a Coloured Analogue Scale ( CAS ) to assess intensity and a facial affective scale to assess the aversive component of pain . Both scales have numerical ratings on the back , so that the person administering it can quickly note the numbers that represent a child 's pain . This study was conducted to determine : the validity of the new instrument by evaluating the psychophysical properties of the intensity scale and by evaluating the discriminant validity of the intensity and affective scales . Since visual analogue scales ( VAS ) are valid and reliable measures for assessing children 's pain , children 's ability to use the new analog scale was compared with their performance on a VAS . Children 's ability to rate pain affect using an affective scale , in which the 9 faces on a Facial Affective Scale ( FAS ) are presented in an ordered sequence from least to most distressed , was compared to their performance on the original FAS , in which the same faces were presented in a r and om order . Using a parallel groups design , 104 children ( 5–16 years ; 60 female , 44 male ; 51 healthy and 53 with recurrent headaches ) were r and omized into two groups : CAS or VAS . Children used the assigned scale to complete a calibration task , in which they rated the sizes of 7 circles varying in area ( 491 , 804 , 1385 , 2923 , 3848 , 5675 and 7854 mm2 ) . The psychophysical function relating perceived circle size to actual physical size was determined for the CAS and VAS . Children 's  CAS and VAS  responses on the calibration task yielded similar mathematical relationships ; & PHgr;cas = 0.035I0.87 , & PHgr;vas = 0.027I0.89 , where & PHgr ; = perceived magnitude and I = stimulus intensity . The R2 values were 0.921 and 0.922 for the CAS and VAS groups , respectively . Analyses of covariance revealed no significant differences in the characteristics of these relationships , i.e. , R2 , slope , or y intercept , by scale type . Children used the same scale to complete the Children 's Pain Inventory ( CPI ) , in which they rated the intensity and affect of 16 painful events ( varying in nature and extent of tissue damage ) . Children 's  CAS and VAS  responses on the CPI were similar . Analyses of covariance indicated that there were no differences in either intensity or affective ratings by scale type . However , the mean number of painful events experienced by children increased significantly with age ( P = 0.0001 ) . Intensity ratings decreased significantly with age ( P = 0.002 ) , but affective ratings did not vary with age . The new instrument has equivalent psychometric properties to a 165 mm VAS . However , the CAS was rated as easier to administer and score than the VAS , so it may be more practical for routine clinical use . Since the CAS has fulfilled the first two criteria for a pain measure ( psychophysical properties and discriminant validity ) , it is ethical to proceed with the formal definitive test for construct validity , in which children from various clinical population s use the CAS scale to assess their own pain STUDY OBJECTIVE We sought to determine the minimum clinical ly significant difference in visual analog scale ( VAS ) pain score for children . METHODS We performed a prospect i ve , single-group , repeated- measures study of children between 8 and 15 years presenting to an urban pediatric emergency department with acute pain . On presentation to the ED , patients marked the level of their pain on a 100-mm nonhatched VAS scale . At 20-minute intervals thereafter , they were asked to give a verbal categoric rating of their pain as " heaps better , " " a bit better , " " much the same , " " a bit worse , " or " heaps worse " and to mark the level of pain  on a VAS scale of the same type as used previously . A maximum of 3 comparisons was recorded for each child . The minimum clinical ly significant difference in VAS pain score was defined as the mean difference between current and preceding scores when the subject reported " a bit worse " or " a bit better " pain . RESULTS Seventy-three children were enrolled in the study , yielding 103 evaluable comparisons in which pain was rated as " a bit better " or " a bit worse . " The minimum clinical ly significant difference in VAS score was 10 mm ( 95 % confidence interval 7 to 12 mm ) . CONCLUSION This study found the minimum clinical ly significant difference in VAS pain score for children aged 8 to 15 years ( on a 100-mm VAS scale ) to be 10 mm ( 95 % confidence interval 7 to 12 mm ) . In studies of population s , differences of less than this amount , even if statistically significant , are unlikely to be of clinical significance Summary The repeatability coefficient of the 100‐mm visual analogue scale in children , a measure of test‐retest reliability , is 12 mm when pain did not change . Abstract In children , many psychometric properties of the  visual analogue scale ( VAS )  are known , including the minimum clinical ly significant difference ( 10 mm on a 100‐mm VAS ) . However , its imprecision or reliability is not well known . Thus , in order to determine the reliability of this scale , a prospect i ve cohort study was performed in patients aged 8–17 years presenting to a pediatric emergency department with acute pain . Pain was grade d 4 times using a paper VAS ( 0–100 mm ) : T0 , T3 , T6 , and T⩾36 minutes . After T6 , patients were asked if their pain had changed since T0 minute . The primary analysis was the repeatability coefficient of the VAS , determined according to the Bl and ‐Altman method for measuring agreement using repeated measures in patients reporting that their pain was the same for T0 , T3 , and T6 . In order to appropriately estimate the within‐subject SD , 96 patients were required if we obtained 3 measurements for each patient . A total of 151 patients with a mean age of 12.2 ± 2.5 years were enrolled . Among them , 100 mentioned that their pain was the same for T0 , T3 , and T6 minutes . The repeatability coefficient of the VAS for these children was 12 mm when the pain did not change . This implies that , for a child , all pain intensity measurements within 12 mm should be considered the same pain intensity on a paper VAS . This measure should also be evaluated on other types of VAS Faces scales have become the most popular approach to eliciting children 's self-reports of pain , although different formats are available . The present study examined : ( a ) the potential for bias in children 's self-reported ratings of clinical pain when using scales with smiling rather than neutral ' no pain ' faces ; ( b ) levels of agreement between child and parent reports of pain using different faces scales ; and ( c ) preferences for scales by children and parents . Participants were 75 children between the ages of 5 and 12 years undergoing venepuncture , and their parents . Following venepuncture , children and parents independently rated the child 's pain using five different r and omly presented faces scales and indicated which of the scales they preferred and why . Children 's ratings across scales were very highly correlated ; however , they rated significantly more pain when using scales with a smiling rather than a neutral ' no pain ' face . Girls reported significantly greater levels of pain than boys , regardless of scale type . There were no age differences in children 's pain reports . Parents ' ratings across scales were also highly correlated ; however , parents also had higher pain ratings using scales with smiling ' no pain ' faces . The level of agreement between child and parent reports of pain was low and did not vary as a function of the scale type used ; parents overestimated their children 's pain using all five scales . Children and parents preferred scales that they perceived to be happy and cartoon-like . The results of this study indicate that subtle variations in the format of faces scales do influence children 's and parents ' ratings of pain in clinical setting OBJECTIVES As pain is a subjective and difficult parameter to assess in children , we aim ed to evaluate the correspondence of two pain scales - parents ' post-operative pain measure  ( PPPM ) and  faces pain scale-revised  ( FPS-R ) with analgesic intake in the assessment of post-tonsillectomy pain in a pediatric population . METHODS Children aged 4 - 10 years ( n=174 ) undergoing tonsillectomy with or without adenoidectomy  had their pain monitored by PPPM and FPS-R over 7 days following surgery . The amount of analgesic ( acetaminophen or dipyrone ) intake was also recorded each day . Linear regression and correlation analysis were performed for pain scales and Poisson regression model for analgesic administration . To evaluate influence of gender linear regression and logistic regression with r and om effects were performed . RESULTS PPPM and FPS-R presented a significant positive correlation ( τ=0.5 ; R(2)=0.36 ; p<0.001 ) . PPPM and FPS-R also showed a significant correlation with analgesic use over the 7 post-operative days ( p<0.0001 ) . No influence of gender was observed in pain levels by both scales . CONCLUSIONS Our data demonstrate that PPPM and FPS-R are equivalent pain scales to quantify post-tonsillectomy pain in children and are useful tools in post-tonsillectomy clinical research STUDY OBJECTIVE In children , the agreement between the many scales used to document the intensity of pain is not well known . Thus , to determine the agreement , we evaluate the visual analog scale , the st and ardized color analog scale , the Wong-Baker FACES Pain Rating Scale , and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department ( ED ) . METHODS Participants were children who were aged 8 to 18 years , presented to a pediatric ED with abdominal pain suggestive of appendicitis , and were recruited to participate in a r and omized controlled trial evaluating the efficacy of morphine . Patients were initially asked to grade their pain on a plasticized color analog scale , a paper visual analog scale , a paper Wong-Baker FACES Pain Rating Scale , and then with a verbal numeric scale . Thirty minutes after morphine or placebo administration , the assessment was repeated . All scores were then converted to a value of 0 to 100 . Agreements between scores were evaluated with the Bl and -Altman method , and the 95 % lower and upper limits were reported . We defined a priori the maximum limit of agreement at + /-20 mm . RESULTS A total of 87 children were included in the study , 58 of them with confirmed appendicitis . The 95 % limits of agreement for each pair of scales were visual analog scale/color analog scale -18.6 , 14.4 ; visual analog scale/Wong-Baker FACES Pain Rating Scale -20.1 , 33.7 ; visual analog scale/verbal numeric scale -30.2 , 20.7 ; color analog scale/Wong-Baker FACES Pain Rating Scale -18.5 , 36.3 ; color analog scale/verbal numeric scale -26.9 , 22.1 ; and Wong-Baker FACES Pain Rating Scale/verbal numeric scale -38.7 , 15.7 . CONCLUSION Our study suggests that only the visual analog scale and the color analog scale have acceptable agreement in children with moderate to severe acute abdominal pain . In particular , the verbal numeric scale is not in agreement with the other evaluated scales Summary The widely used “ optimal ” cut point procedure developed by Serlin et al. in 1995 results in highly variable cut points . This variability obviates any substantial interpretation of differences between groups . Abstract Defining cut points for mild , moderate , and severe pain intensity on the basis of differences in functional interference has an intuitive appeal . The statistical procedure to derive them proposed in 1995 by Serlin et al. has been widely used . Contrasting cut points between population s have been interpreted as meaningful differences between different chronic pain population s. We explore the variability associated with optimally defined cut points in a large sample of chronic pain patients and in homogeneous sub sample s. Ratings of maximal pain intensity ( 0–10 numeric rating scale , NRS ) and pain‐related disability were collected in a sample of 2249 children with chronic pain managed in a tertiary pain clinic . First , the “ optimal ” cut points for the whole sample were determined . Second , the variability of these cut points was quantified by the bootstrap technique . Third , this variability was also assessed in homogeneous sub sample s of 650 children with constant pain , 430 children with chronic daily headache , and 295 children with musculoskeletal pain . Our study revealed 3 main findings : ( 1 ) The optimal cut points for mild , moderate , and severe pain in the whole sample were 4 and 8 ( 0–10 NRS ) . ( 2 ) The variability of these cut points within the whole sample was very high , identifying the optimal cut points in only 40 % of the time . ( 3 ) Similarly large variability was also found in sub sample s of patients with a homogeneous pain etiology . Optimal cut points are strongly influenced by r and om fluctuations within a sample . Differences in optimal cut points between study groups may be explained by chance variation ; no other substantial explanation is required . Future studies that aim to interpret differences between groups need to include measures of variability for optimal cut points & NA ; Altogether 553 children ( 195 first grade rs , mean age 6.8 years , and 358 third grade rs , mean age 8.7 years ) participated in the development of a self‐report measure to assess the intensity of children 's pain .  The first step was the derivation , from children 's drawings of facial expressions of pain , of 5 sets of 7 schematic faces depicting changes in severity of expressed pain from no pain to the most pain possible . With the set of faces that achieved the highest agreement in pain ordering , additional studies were conducted to determine whether the set had the properties of a scale . In one study , children rank‐ordered the faces on 2 occasions , separated by 1 week . All 7 faces were correctly ranked by 64 % ( retest 1 week later , 61 % ) of grade 1 children and by 86 % ( retest 89 % ) of grade 3 children . In a second study , the faces were presented in all possible paired combinations . All 7 faces were correctly placed by 62 % ( retest 86 % ) of the younger and by 75 % ( retest 71 % ) of the older subjects . A third study asked children to place faces along scale : a procedure allowing a check on the e quality of intervals . The fourth study checked on whether pain was acting as an underlying construct for ordering the faces in memory . We asked whether children perceived the set as a scale by asking if memory for an ordered set of faces was more accurate than for a r and om set . The final study checked , with 6‐year‐old children , the test‐retest reliability of ratings for recalled experiences of pain . Overall , the faces pain scale incorporates conventions used by children , has achieved strong agreement in the rank ordering of pain , has indications that the intervals are close to equal , and is treated by children as a scale . The test‐retest data suggest that it may prove to be a reliable index over time of self‐reported pain OBJECTIVES The objective was to assess in a pediatric emergency department ( ED ) the reliability of the color analog scale ( CAS ) for acute pain assessment , overall and between traumatic and nontraumatic pain etiology . METHODS This was a prospect i ve study of children aged 5 to 16 years in the ED of a children 's hospital who had a complaint of pain . The CAS was administered to the patient at admission and at 30 minutes . To evaluate repeatability , a second measurement was obtained 1 minute following each assessment . This assumed there would be no substantial change in pain intensity within 1 minute . The authors used the intraclass correlation coefficient ( ICC ) to evaluate the repeatability of 1-minute interval measurements . RESULTS A total of 170 patients were enrolled . The origin of pain was traumatic in 81 cases ( 48 % ) . Regardless of pain etiology , the  CAS scores were highly repeatable ( r = 0.97 , 95 % confidence interval [ CI ] = 0.95 to 0.98 ) . CONCLUSIONS The color analog scale is both a valid and a reliable self-reporting tool in the assessment of acute pain in children
target: Based on available evidence , the NRS-11 , FPS-R , and CAS were strongly recommended for self-report of acute pain .
  Only weak recommendations could be made for self-report measures for postoperative and chronic pain .
  No measures were recommended for children younger than 6 years , identifying a need for further measurement refinement in this age range .
background: Abstract In 2006 , PAIN published a systematic review of the measurement properties of self-report pain intensity measures  in children and adolescents ( Stinson JN , Kavanagh T , Yamada J , Gill N , Stevens B. Systematic review of the psychometric properties , interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents .
  Key developments in pediatric pain necessitate an up date of this work , most notably growing use of the 11-point numeric rating scale ( NRS-11 ) .
  Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old .
  A secondary aim was to develop evidence -based recommendations for measurement of child and adolescent self-report of acute , postoperative , and chronic pain .