Painful reality: Care providers tend to underestimate pain during pediatric burn dressing changes

A measurement tool called the Face, Legs, Activity, Cry, Consolability Scale (FLACC) is widely used by nurses to rate pain in pediatric patients. It can be applied to pediatric patients of all ages, including the very young, so it provides a standard assessment for all patients in our pediatric burn center. This study found that nurses tended to underrate both mild and severe procedural pain. Nurses who had less nursing experience demonstrated significantly higher accuracy than those with more experience.

Jonathan Groner, MD, is the study's senior author, medical director of the Center for Pediatric Trauma Research and affiliate faculty of the Center for Injury Research and Policy at Nationwide Children's Hospital stated, "This is concerning because it demonstrates that on a well-established burn unit that specializes in caring for pediatric patients, nurses may too often underrate children's procedural pain for both mild and severe pain." Dr. Jiabin Shen, the study's lead author also noted concern that "new" burn nurses (less than 5 years nursing experience) appeared to be more accurate in FLACC rating than more experienced nurses.

This study, available online and in the September issue of Burns, is the first study to systematically examine FLACC rating accuracy among care providers. Developed in 1997, the FLACC scale was originally designed to measure post-operative pain in pediatric populations. The FLACC utilizes an easy-to-understand 0-10 metric and exerts a relatively low burden on medical staff. It has previously demonstrated a high level of inter-rater reliability and concurrent validity with other existing scales. But much of the previous research was not in clinical settings.