What pain scale is suitable for a patient above 3 years old with appendicitis who can visually identify their pain?

Pain Scale Selection for Children Above 3 Years with Appendicitis

For a patient above 3 years old with appendicitis who can visually identify their pain, the Face Pain Rating Scale (specifically the Faces Pain Scale-Revised or Wong-Baker FACES Pain Rating Scale) is the most appropriate choice.

Age-Appropriate Pain Assessment

• Children aged 3-7 years have limited ability to use numeric scales and benefit most from visual/pictorial representations of pain intensity 1
• The Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPRS) have undergone extensive psychometric testing and demonstrate adequate validity and reliability for children in this age group 1
• The numeric pain scale (Option C) is not appropriate for children above 3 years as it requires abstract numerical reasoning that typically develops around age 8 years or older 2, 3

Comparison of Available Options

Face Pain Rating Scales (Option A - CORRECT)

• The FPS-R (scored 0-10) and WBFPRS (scored 0-10) are validated for children as young as 4-5 years and demonstrate strong psychometric properties including construct validity, reliability, and responsiveness 1
• When given a choice between faces scales, children consistently prefer the WBFPRS, though the FPS-R is recommended for research use due to superior utility and lack of confounding affect cues 1
• In children aged 8-18 years with acute abdominal pain suggestive of appendicitis, the visual analog scale and color analog scale showed acceptable agreement, but faces scales remained valid options 2

FLACC Rating Scale (Option B - INCORRECT)

• The FLACC (Face, Legs, Activity, Cry, Consolability) scale is an observational tool designed for children who cannot self-report pain, including infants, preverbal children, or those with cognitive impairment 4
• Since the question specifies the patient "can visually identify their pain," this indicates self-report capability, making FLACC inappropriate 4

Numeric Pain Scale (Option C - INCORRECT)

• The verbal numerical rating scale (vNRS) requires abstract cognitive abilities typically not present until age 8 years or older 2, 3
• Studies comparing vNRS with FPS-R in children aged 8-17 years showed equal efficacy, but data are sparse for children below age 5 years 3, 1
• In children with acute abdominal pain, the verbal numeric scale showed poor agreement with other validated scales, with 95% limits of agreement ranging from -38.7 to 20.7 mm when compared to visual analog scales 2

Behavioral Pain Scale (Option D - INCORRECT)

• Behavioral pain scales are observational measures used when self-report is not possible, not appropriate for children who can self-report 4

Clinical Implementation

• For children aged 3-7 years with appendicitis, use the Faces Pain Scale-Revised or Wong-Baker FACES Pain Rating Scale as the primary pain assessment tool 1
• Ensure the child understands the scale by explaining that the faces show "how much something can hurt" with clear left-to-right progression from no pain to maximum pain 1
• Reassess pain intensity regularly using the same scale to track response to analgesic interventions, as pain control should be a priority in appendicitis management 5

Common Pitfall to Avoid

• Do not use numeric scales in children under 8 years assuming they understand numerical concepts—this leads to unreliable pain assessments and inadequate analgesia 2, 3, 1
• Avoid switching between different pain scales during serial assessments, as this compromises the ability to track changes in pain intensity over time 1