Combination of self-report method and observational method in assessment of postoperative pain severity in 2 to 7 years of age group: A cross-sectional analytical study

Background: Postoperative pain management is based on assessment of severity of pain. Adult patients can express their pain accurately but difficulty occurs in paediatric population. Children between 2 and 7 years of age may give biased response to any scale of pain assessment as they belong to the preoperational stage of cognitive development. Objectives: To establish the agreement between two pain scale, namely Faces Pain Scale-Revised (FPS-R) and Face, Legs, Activity, Cry, Consolability scale (FLACC) regarding assessment of severity of postoperative pain and to find out true negative in terms of specificity of combination of scale for assessment of postoperative pain. Settings and Design: Postoperative recovery unit, cross-sectional analytical study. Materials and Methods: Four hours after short surgical procedure 95 children were assessed by two pain scale and by two observers simultaneously and data submitted to analyser. Statistical Analysis: IBM SPSS (Version 20.0). P < 0.05 was considered as statistically significant. Results: Combination of these two scales show high odds ratio (39%) and kappa coefficient (0.76) suggesting excellent agreement. Specificity of combination of these scales is very high (95.1%) than individual (FPS-R-17.85%, FLACC-2.2%). Spearman's correlation coefficient (ρ) was computed to ascertain the correlation between two scales and a significant positive correlation was found (ρ = 0.727, P = 0.00). Conclusion: FPS-R and FLACC scale has excellent agreement to diagnose the severity of postoperative pain in 2-7 years of age group and combination of these two scales has high specificity to assess the severity of postoperative pain than individual.