All 4 faces pain scales were found to be adequately supported by psychometric data .
When given a choice between faces scales , children preferred the WBFPRS .
Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS .
: For clinical use , we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use .
CONTEXT : Numerous faces scales have been developed for the measurement of  pain intensity in children .
It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity , reliability , feasibility , and preference .
OBJECTIVES : To summarize and systematic ally review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility .
A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures.
STUDY OBJECTIVE We compare adverse events , efficacy , and length of sedation of intravenous ( i.v . ) versus intramuscular ( i.m . ) ketamine procedural sedation and analgesia for orthopedic procedures in the emergency department ( ED ) . METHODS Pediatric patients receiving ketamine for orthopedic procedures were enrolled in a prospect i ve , r and omized , controlled trial in a children 's hospital ED . All patients were initially r and omized to receive ketamine either 1 mg/kg i.v . or 4 mg/kg i.m .  Demographics , adverse events , sedation efficacy , and length of sedation were recorded . RESULTS Two hundred twenty-five patients were r and omized ( 116 i.v . , 109 i.m . ) . Two hundred eight patients , aged 14 months to 15 years , completed the study , 109 i.v . and 99 i.m . Respiratory adverse events were similar between groups ( i.v . 8.3 % versus i.m . 4.0 % ; odds ratio [ OR ] 0.47 ; 95 % confidence interval [ CI ] 0.14 to 1.6 ) . Vomiting in the ED was more common in the i.m . group ( 26.3 % versus 11.9 % ; OR 2.60 ; 95 % CI 1.2 to 5.9 ) . Using the Faces Pain Scale , patients in the i.m . group reported significantly less pain from the procedure . Video observers reported significantly lower distress in the i.m . group during the painful procedure ( Observation Score of Behavioral Distress scores 0.35 i.m . versus 0.74 i.v . ; mean difference 0.38 ; 95 % CI 0.04 to 0.72 ) . Length of sedation was significantly longer in the i.m . group ( median 129 versus 80 minutes ) . Satisfaction of sedation was high in parents and physicians , with no difference in reported satisfaction between groups . This study was terminated early because of nursing resistance based on the longer recovery times observed in patients receiving ketamine i.m . CONCLUSION In this study of pediatric sedation for orthopedic procedures , we found that ketamine 4 mg/kg i.m . was more effective than 1 mg/kg i.v . but demonstrated significantly longer recovery times and more vomiting
All 4 faces pain scales were found to be adequately supported by psychometric data .
When given a choice between faces scales , children preferred the WBFPRS .
Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS .
: For clinical use , we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use .
CONTEXT : Numerous faces scales have been developed for the measurement of  pain intensity in children .
It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity , reliability , feasibility , and preference .
OBJECTIVES : To summarize and systematic ally review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility .