Background Neonates are able to detect and process painful stimuli but are unable to mount a complete response, posing a clinical challenge. Repeated exposure to pain may result in long-term neurodevelopmental sequelae. There is no uniformly agreed method of assessing neonatal pain. Although the “Premature Infants Pain Profile” (PIPP) score is the commonest used worldwide, the “Face, Legs, Activity, Cry and Consolability” (FLACC) score is also often utilised. However, FLACC score has not been validated for infants younger than 2 months old.
Aim To assess validity and reliability of FLACC score in the assessment of neonatal pain responses and collect user feedback.
Method A prospective observational study of infants receiving neonatal care in Singapore General Hospital was performed. Painful responses to common procedures were evaluated. Infants were assessed 5 min before, during and 5 min after the procedure by 2 independent observers (researcher and nurse), who simultaneously scored the infant using both FLACC and PIPP. User feedback was collected.
Results A total of 53 observations of 30 infants were obtained. FLACC meets criterion validity with a correlation coefficient of 0.641 (p-value < 0.01) and construct validity in 1 known group. FLACC has better inter-rater reliability with kappa value of 0.422 as compared to PIPP, kappa value: 0.221. FLACC received better feedback from nurses, with 89% preference over PIPP.
Conclusion FLACC is a valid and reliable tool as compared to the PIPP. FLACC received greater clinical acceptance from the nurses, being less cumbersome and not requiring continuous physiologic parameter monitoring.