Comparison of the Properties of Pain Assessment Tools Between the COMFORT-B Scale and the Modified FLACC Scale in Ventilated Sedated Children During Suctioning

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Kanchana Narktim
Wantanee Wiroonpanich
Pissamai Wattanasit


      The aims of this descriptive study were to evaluate the construct validity by known group technique and multitrait-multimethod technique and to evaluate and compare the reliability of the COMFORT-B scale and the modified FLACC scale. Thirty two ventilated sedated children aged 1 month to 4 years were included in this study. Two nurses who passed training program about the pain assessment tools on the acceptable value of the inter rater reliability (ICC of COMFORT-B scale and modified FLACC scale = .98 and .94 respectively), observed each child from 10 VDOs simultaneously and assessed pain score using both scales before and during endotracheal closed system suctioning. Each period of observations was repeated three times. The personal data were analyzed by using descriptive statistic. The construct validity of known group technique data were analyzed by using a paired-sample-t test and multitrait-multimethod technique data were analyzed by Pearson’s product moment correlation. Inter rater reliability was assessed using the intra-class correlation coefficient (ICC).
       The results revealed that the COMFORT - B and the modified FLACC scale showed construct validity as both scales discriminated pain before and during suctioning (t=-30.98, p< .001 and t=-28.06, p< .001 respectively) and also could measure pain because both scales were correlated (before suctioning r= .23, p= .024 during suctioning r= .73, p= .000). In addition, the inter rater reliability of both scales was equally excellent (ICC= .98).
The results showed that both scales, the COMFORT-B scale and the modified FLACC scale, have construct validity and reliability properties in assessing acute pain. This information can provide evidence base for nurses to choose the most appropriate pain scale to assess pain in children.


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Narktim, K., Wiroonpanich, W., & Wattanasit, P. (2018). Comparison of the Properties of Pain Assessment Tools Between the COMFORT-B Scale and the Modified FLACC Scale in Ventilated Sedated Children During Suctioning. Songklanagarind Journal of Nursing, 38(1), 90–102. Retrieved from
Original Articles


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