Reliability of the Faces, Legs, Activity, Cry, and Consolability Scale in Assessing Acute Pain in the Pediatric Emergency Department

OBJECTIVESThe Faces, Legs, Activity, Cry, and Consolability (FLACC) scale is one of the most widely utilized observational pain assessment scales in clinical practice. Although designed and validated to assess postoperative pain, the tool is currently applied to assess acute pain in multiple settings, including the emergency department. Scarce literature exists evaluating the reliability of the FLACC scale in the nonsurgical population and none in the emergency department. We sought to investigate the reliability of the FLACC scale in assessing acute pain in the pediatric emergency department and to examine the sensitivity of FLACC scores after the administration of analgesia. METHODSIn phase 1 of this prospective study, a series of 2 independent evaluators, blinded to each otherʼs evaluations, scored 66 patients using the FLACC tool. Degree of concordance among the 6 dyads was used to measure interrater reliability. In phase 2, FLACC scores were obtained just before the administration of analgesia in 35 patients and measured at 30 and at 60 minutes after administration. RESULTSAmong the 6 dyads of evaluators, Kendall W demonstrated a strong concordance (27 of 30 measures; range, 0.63–1.00) for individual components of the scale and for the composite scores (range, 0.85–0.96). Significant mean reductions from preanalgesia FLACC scores [5.54; 95% confidence interval (CI), 4.79–6.30] were seen at 30 minutes (2.00; 95% CI, 1.61–2.39) and 60 minutes (1.14; 95% CI, 0.79–1.50) postanalgesia (P < 0.0001 for all comparisons). CONCLUSIONSThe FLACC scale demonstrated high interrater reliability for both individual FLACC items and total scores in a convenience sample of patients aged 6 months to 5 years in a pediatric emergency department. It seems to be an appropriate observational tool to assess acute pain in this population.