EVENDOL Pain Scale

Instrument Name: EVENDOL Pain Scale

Abbreviation: None

Points for Consideration:

Instructions state: 'Note everything you observe, even if you think the symptoms are not due to pain but to fear, tiredness or illness severity'.

Description of Tool:

The EVENDOL pain scale is a 5-item ClinRO developed to measure pain in young children (up to 7 years old) presenting in the accident and emergency department. Clinicians are asked to observe the child and rate their behaviour on a 4-level scale "sign absent", "sign weak or transient", "sign moderate or present about half the time", "sign strong or present almost all the time". Higher scores represent more pain.

Other Related Tools (if applicable):

None identified

Minimum Qualification Required by COA Administrator: PhD or MA

Comment:

None

Year: 2012

Objective of Development:

To assess pain in young children in emergency departments

Population of Development: Age range (therapeutic indication):

Age range: 0-7 years (Pain)

Pediatric Population(s) in which COA has been used:

Children presenting in the pediatric emergency department

COA type: ClinRo

Subscales: Not applicable

Number of Items 5

Mode of Administration: Clinician-rated

Data Collection Mode: Paper and pen administration

Time for Completion: No information

Response Scales: 4-point Likert scale ranging from 0=

Summary of Scoring:

Available scores: Global score ranging from 0 to 15

Weighting: No

Score Interpretation: Higher score = More pain

Evidence of Literature Review: None identified

Evidence of Instrument Review: Yes

Evidence of Clinical or Expert Input: Yes

Evidence of concept elicitation in target patient population: None identified

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: None identified

Recall/Observation Period: Present time

Evidence for Selection of Reponse Options: None identified

Evidence of cognitive interviewing of draft instrument in target patient population: None identified

Evidence of Preliminary Scoring of Items and Domains: Yes

Evidence related to respondent and administrator burden: Yes

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: Yes

Evidence of re-testing the final version: None identified

Internal consistency (Cronbach's alpha): Yes

Evidence of internal consistency: Fournier-Charrière E (2012) Method: Cronbach's alpha Results: 0.70-0.95 Population/Disease: Children aged birth to 83 months; n=291

Test-retest Reliability (ICC):

None identified

Inter-rater/ inter-interviewer reliability (kappa):

Fournier-Charrière E (2012)Interrater reliability- Correlation Coefficient used: Pearsons r and weighted kappa coefficient. Reliability ranged from 0.89-0.98 (p<0.001); k=0.70-0.90 in nurse scores at same time, 0.80 between nurse and researcher scores at 4 timepoints- Population/Disease: n=291 children aged birth to 83 months

Evidence of test-retest or inter-rater reliability: Yes

Concurrent validity (convergent, divergent):

Fournier-Charrière E (2012)
Convergent validity
- Correlation coefficient used: Pearson's r
- Measures: EVENDOL pain scale; Numerical Rating Scale (NRS); Faces Pain Scale-Revised (FPS-R); Children's Hospital of Eastern Ontaria Pain Scale (CHEOPS); Face Legs Activity Cry Consolability (FLACC), Toddler Preschooler Postoperative Pain Scale (TPPPS); Echelle Douluer et inconfort du nouveau-né (EDIN); time points: T1=arrival at emergency department; T2 after antalgic administration; R=rest; M=mobilization.
- Results:
EVENDOL and NRS: 0.79-0.92 depending on time point (p<0.001)
EVENDOL and FPS-R self report: 0.65 (p<0.001)
EVENDOL and EDIN (newborns); FLACC (2 months- 6 years); TPPPS (6 months-6 years); CHEOPs (1 year-6 years): 0.70-0.91 depending on time point at T1-R and T1-M.
- Population/Disease: n=291 children aged birth to 83 months

Fournier-Charrière E (2012)
Divergent validity
- Correlation coefficient used: Pearson's r
- Measures: EVENDOL pain scale vs child's fever, anxiety, fatigue and hunger.
- Results:
No significant correlations were observed (0.12-0.34).
- Population/Disease: n=291 children aged birth to 83 months

Known-group validity:

Fournier-Charrière E (2012)
- Measure/Groups of patients: A priori pain (children with bone fractures n=38) during movement vs rest; a priori pain (illness/injury with varied degrees of pain n=257) vs a priori without pain (non-painful illness n=34).
- A priori hypotheses: Not stated
- Were hypotheses confirmed: Not applicable
- Results:
Children with bone fractures had high EVENDOL scores during movement (median score=12) than at rest (mean difference=4.7 points; p<0.001)
Children with illnesses a priori considered non-painful were allocated lower (not significant p=0.006) EVENDOL scores (mean score=2.6) than children with pain (mean score=4.0)
- Population/Disease: n=291 children aged birth to 83 months

Evidence of Translatability Assessment: Yes

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: None identified

Evidence of Administration Instructions and Training Provided: Yes

Evidence of concurrent validity: Yes

Evidence of known-groups validity: Yes

Evidence of ability to detect change over time: Yes

Ability to detect change (Responsiveness):

Fournier-Charrière E (2012)
- Method: Change in EVENDOL score before and after analgesic treatment was studied.
- Results:
The median EVENDOL scores before and after administration of nalbuphine or morphine (n=30) decreased from 9 to 3 at rest and from 13 to 6 during mobilization of the painful area.
The median EVENDOL scores before and after administration of codeine (n=18_ decreased from 7 to 0 at rest and from 11 to 4 during movement.
The median EVENDOL scores before and after administration of acetaminophen alone (n=63) decreased from 3 to 9 at rest and from 7 to 3 during movement.
- Population/Disease: n=291 children aged birth to 83 months

Responder Thresholds:

None identified

Evidence of responder thresholds: None identified

Fournier-Charrière, E., Tourniaire, B., Carbajal, R., Cimerman, P., Lassauge, F., Ricard, C., Reiter, F., Turquin, P., Lombart, B., Letierce, A., & Falissard, B. (2012). EVENDOL, a new behavioral pain scale for children ages 0 to 7 years in the emergency department: design and validation. Pain, 153(8), 1573–1582. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/22609430/

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Original language: French

Translations: English

Fournier-Charrière, E., Tourniaire, B., Carbajal, R., Cimerman, P., Lassauge, F., Ricard, C., Reiter, F., Turquin, P., Lombart, B., Letierce, A., & Falissard, B. (2012). EVENDOL, a new behavioral pain scale for children ages 0 to 7 years in the emergency department: design and validation. Pain, 153(8), 1573–1582.

Author:
Elisabeth Fournier-Charrière
Pain Unit
Hôpital Bicêtre
Assistance Publique Hôpitaux de Paris
Le Kremlin Bicêtre
France

Contact: elisabeth.fournier-charriere@bct.aphp.fr (E. Fournier-Charrière)

© 2011 - Evendol Group.

The authors allow open access to and free use of the EVENDOL instrument but retain copyright; if it is used, the mention '© 2011 EVENDOL group' is required; the scale can be downloaded from the website https://pediadol.org/, a french site on pediatric pain.

EVENDOL : une échelle pour évaluer la douleur de tout enfant de moins de 7 ans

https://pediadol.org/wp-content/uploads/2006/06/EVENDOL_gb.pdf