儿童疼痛评定量表.doc
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Pain Rating Scales for Children
儿童疼痛评定量表
Choose an instrument to measure pain, 选择一个测量疼痛的工具，giving consideration to the patient's developmental level; 要考虑到病人的发育水平，可能的情况下在(止痛)疼痛措施之前采用此工具；introduce the instrument prior to painful procedures when possible; 自始至终使用一种评估工具评估疼痛水平；use the same instrument consistently to assess level of pain; know the validity and reliability of pain rating scale chosen.了解疼痛评定量表的效度和信度。 A self report tool is appropriate for children greater than 3 years of age and provides the most accurate measure of pain. 一个自身报告工具对于大于三岁的儿童提供了非常精确的疼痛测量措施。
Children experiencing chronic pain need to be assessed for pain at regular intervals to define a baseline rating for pain. 承受慢性疼痛之苦的儿童应该规律的评估疼痛来界定疼痛的基础等级。
Several scales have been developed to aid in measuring pain in nonverbal children. 已经建立了几个评定量表用来帮助测量无口头表达能力的儿童。
From Nursing Care of Infants and Children, 3rd ed., by LF Whaley and DL Wong, 1987. St Louis: Mosby. Copyright 1987, Mosby. Reprinted with permission
FLACC Scale
CategoryScoring123Face面部No particular expression or smile
无特别的表情或微笑Occasional grimace or frown, withdrawn, disinterested偶尔扮鬼脸或皱眉，孤独，无所欲求Frequent to constant quivering chin, clenched jaw持续或间断下巴颤动，牙关紧咬Legs腿Normal position or relaxed正常体位或放松Uneasy, restless, tense不自在，不安静，紧张Kicking, or legs drawn up踢打，或腿扭曲Activity活动Lying quietly, normal position, moves easily静卧，正常体位，随意的活动Squirming, shifting back and forth, tense不安，前后移动，紧张Arched, rigid or jerking
弓形体位，僵硬或痉挛Cry哭No cry (awake or asleep)无哭泣(清醒或未睡)Moans or whimpers; occasional complaint呻吟或啜泣，抱怨不适Crying steadily, screams or sobs, frequent complaints不停哭泣，尖叫或呜咽，频繁抱怨不适Consolability
对安慰的反应Content, relaxed满意，放松Reassured by occasional touching, hugging or being talked to, distractible通过抚摸摇晃，谈话使其安心，容易出现不专心Difficult to console or comfort难以使其安心舒适
Each of the five categories is scored from 0-2, which results in a total score between zero and ten. 以上每一种分数[(F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Consolability]从0分到2分，最后总分从0到10分。
From The FLACC: A behavioral scale for scoring postoperative pain in young children, by S Merkel and others, 1997, Pediatr Nurse 23(3), p. 293-297. Copyright 1997 by Jannetti Co. University of Michigan Medical Center. Reprinted with permission.
Riley Infant Pain Scale Assessment Tool
BehaviorScoring0123Facial面部Neutral/smiling
中性/微笑Frowning/grimacing皱眉/扮鬼脸Clenched teeth牙关紧咬Full cry expression哭喊的表情Body Movement身体活动Calm, relaxed安静放松Restless/fidgeting不安静烦乱不安Moderate agitation or moderate mobility中度激动不安 或 中度活动Thrashing, flailing, incessant agitation or strong voluntary immobility捶打持续激动不安或强烈的自愿不活动Sleep睡眠Sleeping quietly with easy respirations睡眠安静 呼吸平稳Restless while asleep 睡眠时不安定Sleeps intermittently (sleep/awake)睡眠间歇(睡/醒)Sleeping for prolonged periods of time interrupted by jerky movements or unable to sleep睡眠被抽筋长时间打断，甚至不能入睡Verbal/vocal 声音No cry不哭Whimpering,啜泣complaining诉苦Pain crying痛哭Screaming, high-pitched cry尖叫或高音调哭喊Consolability是否容易安慰Neutral中性Easy to console容易抚慰Not easy to console不易抚慰Inconsolable无法安慰Response to Movement/Touch对被触摸/活动的反应Moves easily活动自如Winces when touched/moved 被触摸/活动时退缩Cries out when moved/touched被触摸/活动时喊叫High-pitched cry or scream when touched or moved被触摸/活动时高调哭喊或尖叫
From Comparison of Three Preverbal Scales for Post Operative Pain Assessment in a Diverse Pediatric Sample, by JG Schade, BA Joyce, J Gerkensmeyer, and JF Keck, 1996, J of Pain and Symptom Management 12(6) p. 348-359. Copyright 1996 Elsevier Science Inc. Reprinted with permission.
Other Pain Assessment Scales
Tools and AuthorsAges of UseReliability and ValidityObjective Pain Score (OPS)
(Hannallah and others, 1987)4 months-18 years*No testing in original publication
*Later tested by original authors
*1988-concurrent validity with Linear Analogue Pain Scale, Spearman's r = 0.721 with scores ￥ 6 and 0.419 with scores < 6
*1991-interrater agreement, coefficient alpha = 0.986 for one rater and 0.983 for the other
*1991-concurrent validity with CHEOPS, Pearson correlation coefficient = 0.88 and 0.94 Children's Hospital of Eastern Ontario Pain Scale (CHEOPS)
(McGrath and others, 1985)1-5 years*Interrater reliability = 90%-99.5%
*Internal correlation = significant correlations between pairs of items
*Concurrent validity between CHEOPS and VAS = 91; between individual and total scores of CHEOPS and VAS = 0.50-0.86
*Construct validity with preanalgesia and postanalgesia scores = 9.9 - 6.33 Nurses Assessment of Pain Inventory (NAPI)
(Stevens, 1990)newborn-16 years*Not tested by original author. Later tested by Joyce and others (1994).
*Interrater agreement: weighted kappa 0.37-0.80
*Discriminant validity: statistically significant differences between preanalgesia and postanalgesia scores ( p < .0001)
*Reliability: Cronbach's alpha = 0.35-0.69 Behavioral Pain Score (BPS)
(Robieux and others, 1991)3-36 months*Original article stated, "reliability of the BAS and BPS scores was tested by a k test"; no further testing of reliability or validity was mentionedModified Behavioral Pain Scale (MBPS)
(Taddio and others, 1995)4-6 months*Concurrent validity between MBPS and VAS scores = correlation coefficient 0.68 (p < 0.001) and 0.74 (p < 0.001)
*Construct validity using prevaccination and postvaccination scores with EMLA vs. placebo: significantly lower scores with EMLA (p < 0.01)
*Internal consistency of items = significant correlations between items
*Interrater agreement: ICC = 0.95, p < 0.001
*Test-retest reliability: r = 0.95, p < 0.001 Riley Infant Pain Scale (RIPS)
(Schade and others, 1996)< 36 months and children with cerebral palsy*Interrater agreement using Intraclass Correlation Coefficient = 0.53-0.83, p < 0.0001
*Discriminant validity using Mann-Whitney U test with preanalgesia and postanalgesia scores = statistically significant (p < 0.001)
*Sensitivity = 0.31-0.23......（后略) ......
Pain Rating Scales for Children
儿童疼痛评定量表
Choose an instrument to measure pain, 选择一个测量疼痛的工具，giving consideration to the patient's developmental level; 要考虑到病人的发育水平，可能的情况下在(止痛)疼痛措施之前采用此工具；introduce the instrument prior to painful procedures when possible; 自始至终使用一种评估工具评估疼痛水平；use the same instrument consistently to assess level of pain; know the validity and reliability of pain rating scale chosen.了解疼痛评定量表的效度和信度。 A self report tool is appropriate for children greater than 3 years of age and provides the most accurate measure of pain. 一个自身报告工具对于大于三岁的儿童提供了非常精确的疼痛测量措施。
Children experiencing chronic pain need to be assessed for pain at regular intervals to define a baseline rating for pain. 承受慢性疼痛之苦的儿童应该规律的评估疼痛来界定疼痛的基础等级。
Several scales have been developed to aid in measuring pain in nonverbal children. 已经建立了几个评定量表用来帮助测量无口头表达能力的儿童。
From Nursing Care of Infants and Children, 3rd ed., by LF Whaley and DL Wong, 1987. St Louis: Mosby. Copyright 1987, Mosby. Reprinted with permission
FLACC Scale
CategoryScoring123Face面部No particular expression or smile
无特别的表情或微笑Occasional grimace or frown, withdrawn, disinterested偶尔扮鬼脸或皱眉，孤独，无所欲求Frequent to constant quivering chin, clenched jaw持续或间断下巴颤动，牙关紧咬Legs腿Normal position or relaxed正常体位或放松Uneasy, restless, tense不自在，不安静，紧张Kicking, or legs drawn up踢打，或腿扭曲Activity活动Lying quietly, normal position, moves easily静卧，正常体位，随意的活动Squirming, shifting back and forth, tense不安，前后移动，紧张Arched, rigid or jerking
弓形体位，僵硬或痉挛Cry哭No cry (awake or asleep)无哭泣(清醒或未睡)Moans or whimpers; occasional complaint呻吟或啜泣，抱怨不适Crying steadily, screams or sobs, frequent complaints不停哭泣，尖叫或呜咽，频繁抱怨不适Consolability
对安慰的反应Content, relaxed满意，放松Reassured by occasional touching, hugging or being talked to, distractible通过抚摸摇晃，谈话使其安心，容易出现不专心Difficult to console or comfort难以使其安心舒适
Each of the five categories is scored from 0-2, which results in a total score between zero and ten. 以上每一种分数[(F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Consolability]从0分到2分，最后总分从0到10分。
From The FLACC: A behavioral scale for scoring postoperative pain in young children, by S Merkel and others, 1997, Pediatr Nurse 23(3), p. 293-297. Copyright 1997 by Jannetti Co. University of Michigan Medical Center. Reprinted with permission.
Riley Infant Pain Scale Assessment Tool
BehaviorScoring0123Facial面部Neutral/smiling
中性/微笑Frowning/grimacing皱眉/扮鬼脸Clenched teeth牙关紧咬Full cry expression哭喊的表情Body Movement身体活动Calm, relaxed安静放松Restless/fidgeting不安静烦乱不安Moderate agitation or moderate mobility中度激动不安 或 中度活动Thrashing, flailing, incessant agitation or strong voluntary immobility捶打持续激动不安或强烈的自愿不活动Sleep睡眠Sleeping quietly with easy respirations睡眠安静 呼吸平稳Restless while asleep 睡眠时不安定Sleeps intermittently (sleep/awake)睡眠间歇(睡/醒)Sleeping for prolonged periods of time interrupted by jerky movements or unable to sleep睡眠被抽筋长时间打断，甚至不能入睡Verbal/vocal 声音No cry不哭Whimpering,啜泣complaining诉苦Pain crying痛哭Screaming, high-pitched cry尖叫或高音调哭喊Consolability是否容易安慰Neutral中性Easy to console容易抚慰Not easy to console不易抚慰Inconsolable无法安慰Response to Movement/Touch对被触摸/活动的反应Moves easily活动自如Winces when touched/moved 被触摸/活动时退缩Cries out when moved/touched被触摸/活动时喊叫High-pitched cry or scream when touched or moved被触摸/活动时高调哭喊或尖叫
From Comparison of Three Preverbal Scales for Post Operative Pain Assessment in a Diverse Pediatric Sample, by JG Schade, BA Joyce, J Gerkensmeyer, and JF Keck, 1996, J of Pain and Symptom Management 12(6) p. 348-359. Copyright 1996 Elsevier Science Inc. Reprinted with permission.
Other Pain Assessment Scales
Tools and AuthorsAges of UseReliability and ValidityObjective Pain Score (OPS)
(Hannallah and others, 1987)4 months-18 years*No testing in original publication
*Later tested by original authors
*1988-concurrent validity with Linear Analogue Pain Scale, Spearman's r = 0.721 with scores ￥ 6 and 0.419 with scores < 6
*1991-interrater agreement, coefficient alpha = 0.986 for one rater and 0.983 for the other
*1991-concurrent validity with CHEOPS, Pearson correlation coefficient = 0.88 and 0.94 Children's Hospital of Eastern Ontario Pain Scale (CHEOPS)
(McGrath and others, 1985)1-5 years*Interrater reliability = 90%-99.5%
*Internal correlation = significant correlations between pairs of items
*Concurrent validity between CHEOPS and VAS = 91; between individual and total scores of CHEOPS and VAS = 0.50-0.86
*Construct validity with preanalgesia and postanalgesia scores = 9.9 - 6.33 Nurses Assessment of Pain Inventory (NAPI)
(Stevens, 1990)newborn-16 years*Not tested by original author. Later tested by Joyce and others (1994).
*Interrater agreement: weighted kappa 0.37-0.80
*Discriminant validity: statistically significant differences between preanalgesia and postanalgesia scores ( p < .0001)
*Reliability: Cronbach's alpha = 0.35-0.69 Behavioral Pain Score (BPS)
(Robieux and others, 1991)3-36 months*Original article stated, "reliability of the BAS and BPS scores was tested by a k test"; no further testing of reliability or validity was mentionedModified Behavioral Pain Scale (MBPS)
(Taddio and others, 1995)4-6 months*Concurrent validity between MBPS and VAS scores = correlation coefficient 0.68 (p < 0.001) and 0.74 (p < 0.001)
*Construct validity using prevaccination and postvaccination scores with EMLA vs. placebo: significantly lower scores with EMLA (p < 0.01)
*Internal consistency of items = significant correlations between items
*Interrater agreement: ICC = 0.95, p < 0.001
*Test-retest reliability: r = 0.95, p < 0.001 Riley Infant Pain Scale (RIPS)
(Schade and others, 1996)< 36 months and children with cerebral palsy*Interrater agreement using Intraclass Correlation Coefficient = 0.53-0.83, p < 0.0001
*Discriminant validity using Mann-Whitney U test with preanalgesia and postanalgesia scores = statistically significant (p < 0.001)
*Sensitivity = 0.31-0.23......（后略) ......
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