Examining the validity, reliability, and preference of three pediatric pain measurement tools in African-American children.

To compare the validity, reliability, and preference of pain intensity measurement tools--the African-American Oucher Scale, the Wong-Baker FACES Scale, and the Visual Analog Scale (VAS)--in 100 African-American children between 3 and 18 years of age.During a visit to the sickle cell anemia clinic, the children were asked to describe two painful procedures/treatments they had experienced and to choose which one hurt the most. They rated the pain intensity of each procedure/treatment on the three scales that were presented in a preselected order. After using all the scales, the children then chose their favorite scale. The same procedure was repeated at the end of the visit, with a minimum of 15 minutes between the test and retest.Concurrent validity was determined by comparing the rank order of the two identified painful items with the pain scores on the three scales. Chi square analysis indicated a statistically significant difference among the scales for preference (chi2 = 24.08, df = 2, p < 0.0001) and reliability (chi2 = 6.12, df = 2, p < 0.05), but not validity (chi2 = 0.81, df = 2, NS) for the entire sample. Most children preferred using the FACES Scale (56%) versus the Oucher (26%) and VAS (18%). When the data were analyzed for three cognitive stages (ages 3-7, 8-12, and 13-18 years), the following were found: For the school-age period, chi square for reliability did not reach significance (chi2 = 4.35, df = 2, NS); for the preschool-age period, chi square for validity did reach significance (chi2 = 6.49, df = 2, p < 0.05) and was strongest for the FACES scale, followed by the Oucher.The study findings indicated that the FACES and African-American Oucher Scales are valid and reliable tools for measuring pain in children. Among the entire sample and each age group, the FACES scale was the most preferred scale.