Evaluation of nurse accuracy in rating procedural pain among pediatric burn patients using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale

Accurate pain assessment is essential for proper analgesia during medical procedures in pediatric patients. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale has previously been shown to be a valid and reliable tool for assessing pediatric procedural pain in research labs. However, no study has investigated how rater factors (gender, number of dressing changes performed/week, burn history, having children, nursing experience, stress at home/work) and patient factors (pain intensity) affect the accuracy of FLACC ratings for procedural pain when implemented by bedside care providers. Twenty-four nurses in an ABA verified Pediatric Burn Center watched four videos of dressing changes for pediatric burn patients in random order three times and rated the children's procedural pain using the FLACC scale. The four videos had standard FLACC scores established by an interdisciplinary panel. Descriptive and mixed modeling analysis was conducted to explore nurse rating accuracy and to evaluate the rater and patient factors that influenced the rating accuracy. The highest accuracy was reached when rating high procedural pain (with a FLACC of 6). Nurses underrated both mild and severe procedural pain. Nurses who had less nursing experience demonstrated significantly higher accuracy than those with more experience. The present study is the first study in the literature to systematically examine the factors influencing the accuracy of FLACC rating for pediatric procedural pain among bedside care providers. The findings suggest that nurse clinical experience and patient pain intensity are two significant contributors to rating accuracy.