• T R Vetter and E J Heiner.
• Department of Anesthesiology, Children's Hospital Medical Center of Akron, OH 44308, USA.
• J Clin Anesth. 1996 Aug 1;8(5):371-5.

Study ObjectiveTo assess the correlation in an older pediatric population between patient self-reported visual analog scale (VAS) pain scores and observational pain-related behavior scores.DesignProspective, comparative study.SettingInpatient surgical units of a free-standing children's hospital.Patients30 ASA physical status I and II outpatients, 8 to 16 years of age, undergoing a variety of orthopedic, plastic, urologic, and general surgical procedures.InterventionsEach patient underwent a single assessment of pain intensity on the first postoperative day.Measurements And Main ResultsThree health care providers (a clinical nurse specialist, a registered nurse with extensive pediatric experience, and a child life specialist) simultaneously generated an independent pain-related behavioral score (range of 0 = no pain to 100 = worst pain possible) based on their subjective perceptions of the patient's observed facial expression, activity level, and breathing pattern. The patient was then asked to provide a self-reported VAS pain score (range of 0 = "no pain" with a smiling face, to 100 = "worst pain ever" with a frowning face). A single set of such concurrent pain scores was obtained once from each study patient. The pain-related behavior scores displayed a satisfactory interrater reliability, with an observed interclass correlation coefficient (Cohen's kappa value) of 0.83. When compared with a patient's self-reported VAS score, the three pain related behavioral scores generated by each health care provider for a given patient exhibited both variable and minimal correlation.ConclusionsA tenuous relationship may exist between on older child's own perception of pain intensity and his or her behavioral expression of that pain as interpreted by a health care provider.

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