Facial Action Summary Score

Instrument Name: Facial Action Summary Score

Abbreviation: FASS

Points for Consideration:

None

Description of Tool:

The Facial Action Summary Score (FASS) is a 5-item ClinRO, developed from facial video sequences of children in the peri-operative period using 5-items representing different face movements of child pain. A facial drawing illustrates the facial expressions of pain for five action units. Clinicians code 1 (with a cross) for the presence or 0 (no cross) for the absence of each item. Higher scores represent greater pain.

Other Related Tools (if applicable):

None identified

Minimum Qualification Required by COA Administrator: PhD or MA

Comment:

None

Year: 2009

Objective of Development:

The primary objective was to determine a criterion index to study the validity of behavior rating scales

Population of Development: Age range (therapeutic indication):

Age range: <7 years (Pain)

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

Children <7 years from a post-anesthesia care unit

COA type: ClinRO

Number of Items 5 items

Mode of Administration: Clinician-rated

Data Collection Mode: Pen and paper administration

Time for Completion: None identified

Response Scales: Pictorial scale with facial expressions of pain for the five action units (brow lower, eye squeeze, deepened naso-labial furrows, upper lip raiser, lower lip depressor) scored with 1=presence or 0=absence

Summary of Scoring:

Available scores: Total score ranging from 0 to 5

Weighting: No

Score Interpretation: Higher score=Greater 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: None identified

Evidence related to respondent and administrator burden: None identified

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: Yes

Internal consistency (Cronbach's alpha): Yes

Evidence of internal consistency: Bringuier S (2021) - Method: Cronbach's alpha. - Results: 0.89 - Population/Disease: Children <7years of age in post-anesthesia care; n=123

Test-retest Reliability (ICC):

None identified

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

Bringuier S (2009)
Interrater reliability
- Correlation Coefficient used: Intraclass Correlation (ICC) and kappa coefficient. Reliability for the total score was 0.94 (95% CI, 0.93-0.95). Reliability ranged from 0.86 to 0.94 for the five items (kappa coefficient 0.86 to 0.94); p not stated
- Population/Disease: n=123 children <7years of age in post-anesthesia care

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

Concurrent validity (convergent, divergent):

Convergent validity
Correlation coefficient used: Pearson or Spearman correlation coefficients (r)
Measures: FASS; Faces Pain Scale-Revised (FPS-R); Face, legs, activity, cry, consoling (FLACC)
Results:
FPS-R: (r=0.8; p<0.0001) FLACC: (r=0.9; p<0.0001) Population/Disease: n=123 children <7years of age in post-anesthesia care (Bringuier et al., 2021). Divergent validity Correlation coefficient used: Pearson or Spearman correlation coefficients (r) Measures: Facial Action Summary Score (FASS); Visual Analog Scale-Anxiety Results: r=0.6; p<0.0001 Population/Disease: n=123 children <7years of age in post-anesthesia care (Bringuier et al., 2021).

Known-group validity:

None identified

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: None identified

Evidence of Administration Instructions and Training Provided: None identified

Evidence of concurrent validity: Yes

Evidence of known-groups validity: None identified

Evidence of ability to detect change over time: Yes

Ability to detect change (Responsiveness):

Bringuier S (2021)
- Method: FASS was assessed before and after rescue analgesia
- Results: There was a significant decrease of scores after rescue analgesia (β-2.75 [−2.96–2.54] p < .0001) - Population/Disease: Children <7years of age in post-anesthesia care; n=123

Responder Thresholds:

None identified

Evidence of responder thresholds: None identified

Bringuier, S., Picot, M. C., Dadure, C., Rochette, A., Raux, O., Boulhais, M., & Capdevila, X. (2009). A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations. Pain, 145(1-2), 60–68. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/19577364/

Bringuier, S., Macioce, V., Boulhais, M., Dadure, C., & Capdevila, X. (2021). Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score. European journal of pain (London, England), 25(5), 1081–1090. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/33428820/

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https://doi.org/10.1002/ejp.1729