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 .
Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department.
STUDY OBJECTIVE In children , the agreement between the many scales used to document the intensity of pain is not well known . Thus , to determine the agreement , we evaluate the visual analog scale , the st and ardized color analog scale , the Wong-Baker FACES Pain Rating Scale , and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department ( ED ) . METHODS Participants were children who were aged 8 to 18 years , presented to a pediatric ED with abdominal pain suggestive of appendicitis , and were recruited to participate in a r and omized controlled trial evaluating the efficacy of morphine . Patients were initially asked to grade their pain on a plasticized color analog scale , a paper visual analog scale , a paper Wong-Baker FACES Pain Rating Scale , and then with a verbal numeric scale . Thirty minutes after morphine or placebo administration , the assessment was repeated . All scores were then converted to a value of 0 to 100 . Agreements between scores were evaluated with the Bl and -Altman method , and the 95 % lower and upper limits were reported . We defined a priori the maximum limit of agreement at + /-20 mm . RESULTS A total of 87 children were included in the study , 58 of them with confirmed appendicitis . The 95 % limits of agreement for each pair of scales were visual analog scale/color analog scale -18.6 , 14.4 ; visual analog scale/Wong-Baker FACES Pain Rating Scale -20.1 , 33.7 ; visual analog scale/verbal numeric scale -30.2 , 20.7 ; color analog scale/Wong-Baker FACES Pain Rating Scale -18.5 , 36.3 ; color analog scale/verbal numeric scale -26.9 , 22.1 ; and Wong-Baker FACES Pain Rating Scale/verbal numeric scale -38.7 , 15.7 . CONCLUSION Our study suggests that only the visual analog scale and the color analog scale have acceptable agreement in children with moderate to severe acute abdominal pain . In particular , the verbal numeric scale is not in agreement with the other evaluated scales
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 .