Background:The FLACC (Facial expression, Leg movement, Activity, Cry, Consalability) behavioral pain assessment scale was developed and validated by Merkel and colleagues among American children last 1997 for autepain assessment of children 2 months to 7 years of age. Since then, it has been validated among other nationalities. It is now being used in Scotland, Australia, Canada and Thailland. This study aimed to determine the inter-reter reliability and construct validity of the FLACC on Filipino posoperative pediatric patients. Methods: A total of 106 children less than 5 years of age (1,68+1.46 years) who were admitted in the Philippine General Hospital Post Anesthesia Care Unit (PACU) were included. Those who are operated on an emergency basis, had neurologic impairment, had developmental delay and required menchanical ventilation postoperatively were excluded. Prior to the data collection phase, the PACU nurses were trained to use the FLACC scale using videotapes of postoperative children. Whenever possible, children were silmultaneuosly rated by two idependent ratersdurig their stay in the PACU. Those with FLACC scores>4 were given an intervention and the pain measurement was repeated and reported accordingly. Results: Inter-rater reliability was good to very good with kappa values for the pain behavior items ranging from 0.75 to 0.82. Construct validity ws established by showing a statistically significant reduction (p<0.001) beteen the pre-intervention score and post-intervention score using Wilcoxon signed rank test. Conclusion: The FLACC exhibited bith inter-rater reliability and contruct validity in the measurement of acute postoperative pain in Filipino children less than 5 years old.
Human ; Child Preschool ; Infant ; PAIN MEASUREMENT ; PAIN ; PEDIATRICS ; PAIN, POSTOPERATIVE

Objective: Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients. Methods: Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign. Results: Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p<0.001). Conclusion and Recommendation There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis maybe necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.
Hyperuricemia ; Gout

Objective: Musculoskeletal ultrasound has gained recognition in early identification of crystal deposits in the joints and soft tissues. This study aims to validate the sonographic features of 1st metatarsophalangeal joints (MTPJs) in gout and asymptomatic hyperuricemia (AH). Methods Patients with gout (n=20) and AH (n=16) underwent a gray-scale ultrasound assessment of both 1st MTPJs on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 blinded trained sonologists for the presence of double contour sign (DCS), erosions, and tophi.
Gout ; Validation Study