P (Population of interest): ____Children 3 to 7 years of age undergoing oncology therapy __________
I (Intervention of interest): ____Use of FLACC assessment tool for pain_____________
C (Comparison of interest): ___Use of FACES assessment tool for pain _____________
O (Outcome of interest): ______Improved assessment of pain levels and management of pain._______________
T (Time): ______Within first ten hours of therapy________________________________
Who What Occurred Where
Articles Involved Completed When Why How Consistencies Gaps
Razmus, I.S., Male Pain assessment Midwest 30 2002 over Determining better way to 9 procedural/analgesia Pain assessment Did not
Dalton, M.E., Newborns during circumcision bed Level 1 a 2 month provide pain relieve and groups; Modified not standard support
Wilson, D. (term or after Nursery period in pain assessment during Bonforroni procedure nursing practice other study
near term) analgesia/anesthesia Spring circumcision procedure used during findings
Voepel-Lewis, Children 4- Assessed pain using Midwest 2002 Validity and reliability for 140 observations used; Test/retest Inability to
T., Merkel, S., 18 years of FLACC before and hospital the FLACC tool on assessed at time of reliability obtain self-
Tait, A.R., age, N = 79 after IV analgesia; children with cognitive procedure; videotaped; confirmed; report of
Trzcinka, A., videotaped compared impairment determined rescored at 2 to 3 months excellent pain score
& Malviya, S. to visual analog scale after the initial correlation and
assessment; test/retest exact agreement
Manworren, N = 147; Assessment of tool PICU, 2003 Test validity of FLACC ANOVA; standard pain 5 Pedi nurses Further
R.C.B. & children with pre-verbal PACU, pain assessment tool in management; FLACC taught related to evaluation
Hynan, L.S. less than 3 children in pain surgical- response to analgesic done prior to pain inter-rater needed on
years of age trauma unit, treatment; 10 and 30 reliability; useful tool
hematology- minutes post IV pain scale of pain
oncology medication; 10 and 60
unit, infant minutes post oral
units; medication treatment.
Willis, N = 30; 3 to FLACC scale assigned Michigan 2003 Further test validity of Descriptive, observation Construct Non specific
M.H.W., 7 years old and FACES scale FLACC study validity with
Merkel, S.I., with variety scores obtained at 20 confirmed with children
Voepel-Lewis, of surgical minutes and 2 hours children 5-7 y/o under the
T., & procedures age of 5
Summary of findings:
FLACC tool has ongoing support of it’s validity and reliability to assess pain in children
Tool is effective when used with pre-verbal children, children between the ages of 5 and 7, and cognitive impairment
Tool does not reflect significant assessment of children less than 5 years of age.
Application of findings to evidence-based practice that validates/changes policies and procedures:
A policy related to the use of the FLACC pain assessment tool would need to be developed
Interdepartmental training in the use of the FLACC pain assessment tool would need to be completed.
Manworren, R.C.B. & Hynan, L.S. (2003). Clinical validation of FLACC: Preverbal patient pain
scale. Pediatric Nursing 29(2), 140-146.
Razmus, I.S., Dalton, M.E., & Wilson, D. (2004). Pain management for newborn circumcision.
Pediatric Nursing 30(5), 414-427.
Voepel-Lewis, T., Merkel, S., Tait, A.R., Trzcinka, A., & Malviya, S. (2002). The reliability and
validity of the face, leg, activity, cry, consolability observation tool as a measure of pain in children with
cognitive impairment. Pediatric Anesthesia 95, 1224-1229.
Willis, M.H.W., Merkel, S.I., Voepel-Lewis, T., & Malviya, S. (2003). FLACC behavioral pain
assessment scale: A comparison with the child’s self-report. Pediatric Nursing 29(3), 195-198