Underestimating Children's Self-reported Pain: Agree/Disagree?

Objective: To compare postoperative pain after different surgical types and grades using the visual analogue scale (VAS) and numeric rating scale (NRS) evaluated by the patient, parent, and nurse. Methods: After approval from the local ethics committee and written informed consent from the patient and parent, a single-center, prospective, randomized study was designed. A total of 180 children with American Society of Anesthesiologists I-III physical status between the ages of 7-12 (n = 90) and 13-18 (n = 90) years were included in the study who underwent elective surgery at Ankara University Faculty of Medicine Hospitals between January and December 2022. Pain was assessed postoperatively at 2 hours using two pain scales. Patients who underwent mini-intermediate or major surgery were evaluated separately. Results: Four children from each age group were excluded from the study due to insufficient data recording, and data from 172 children were analyzed. Including all age groups and surgical grades, all children had excellent agreement with the parent [VAS/NRS: intraclass correlation coefficient (ICC)= 0.903/ICC= 0.900] and good agreement was found between the child and nurse (VAS/NRS: ICC= 0.852/ICC= 0.842). For the VAS and NRS, when parent and nurse compliance scores were compared, no significant difference was observed between the two scores. For VAS and NRS, fathers were found to be better at predicting pain for children than mothers. Conclusion: Self-reported pain is the gold standard for pain evaluation. The parents assessed pain scores that were similar to those of their children using NRS and VAS. Nurses underestimated a child's pain with both scores.