1. 2025;28;183-196A Systematic Review of Self-Reported Pain Rating Scales for Children and Adolescents
   Systematic Review
   Joshua Calvano, DO, Reza Ehsanian, MD, PhD, Jordan A. Buttner, BS, Adi Balk, BS, Deborah Lai, BS, Matt McGillivray, BS, Todd Jaffe, MD, and Shuhan He, MD.

BACKGROUND: Pain assessment in pediatric populations via self-report tools pose unique challenges given the patients’ cognitive abilities and developmental status; however, the accurate measurement of pediatric pain is crucial in improving patient outcomes.

OBJECTIVES: This review evaluates recent medical literature to better understand potential correlations and concordance exhibited by self-reported pain intensity assessment tools for children and adolescents in addition to assessing the viability and utility of electronic delivery modalities.

STUDY DESIGN: Systematic review without meta-analysis.

METHODS: An online database search was conducted utilizing PubMed/MEDLINE, EMBASE, and Google Scholar. Screened studies were limited to documents published between June 2004 and January 2022. All included studies were published in English, focused on pediatric self-report scales, and included comparisons of at least 2 different scales or various delivery modalities of the same scale. Risk of bias was assessed per the Cochrane Systematic Review Handbook.

RESULTS: A total of 19 articles were selected for inclusion in this review. The findings indicate that pain scales incorporating visual aids, such as faces and colors, exhibit strong correlations with other pain assessment scales. However, discriminating between pediatric pain scales is still more nuanced, as evidenced by the contrasting paired correlation results shown between 2 similar face-based scales, underscoring the potential differences in the perception of fine details included within the visuals.

LIMITATIONS: Limitations of this review include its focus on specific pain intensity metrics in children aged 3 to 18 without consideration of cognitive age or inclusion of articles about both acute and chronic pain. Study section and publication bias may have impacted the general findings, as is true of any systematic review.

CONCLUSIONS: Self-report pain scales that include visual aids such as colors and facial features may allow for the better assessment of pediatric pain than do pain scales without visual aids; however, additional research is required to fully elucidate the effects of such elements. This systematic review suggests that a universal, emoji-based electronic pain scale may enhance reporting accuracy and allow personalization for pediatric patients from various backgrounds.

KEY WORDS: Pain, pain diagnosis, pain intensity, pain rating, pain scales, pain assessment, children pain, adolescent pain