Inter-Rater Reliability of the Feline Grimace Scale in Cats Undergoing Dental Extractions.

Ryota Watanabe,Graeme M Doodnaught,Beatriz P Monteiro,Marina C Evangelista,Hélène L M Ruel,Paulo V Steagall

doi:10.3389/fvets.2020.00302

Ryota Watanabe, Graeme M Doodnaught + Show 4 more

Open Access

https://doi.org/10.3389/fvets.2020.00302

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Abstract

This study aimed to evaluate the inter-rater reliability of the Feline Grimace Scale (FGS) in cats undergoing dental extractions and the effects of the caregiver's presence on the FGS scores. Twenty-four cats (6 ± 3.3 years old; 4.9 ± 1.7 kg) undergoing oral treatment were included in a prospective, blinded, randomized, clinical study. They underwent treatment under general anesthesia (acepromazine-hydromorphone-propofol-isoflurane-meloxicam-local anesthetic blocks) at day 1 and were discharged at day 6. Images of cat faces were captured from video recordings with or without the caregiver's presence at 6 h postoperatively (day 1), day 6, and before and after rescue analgesia. Images were randomized and independently evaluated by four raters using the FGS [five action units (AU): ear position, orbital tightening, muzzle tension, whiskers change, and head position; score 0–2 for each]. Inter-rater reliability and the effects of the caregiver's presence were analyzed with intraclass correlation coefficient [single measures (95% confidence interval)] and the Wilcoxon signed-rank test, respectively (p < 0.05). A total of 91 images were scored. Total FGS scores showed good inter-rater reliability [0.84 (0.77–0.89)]. Reliability for each AU was: ears [0.68 (0.55–0.78)], orbital tightening [0.76 (0.65–0.84)], muzzle [0.56 (0.43–0.69)], whiskers [0.64 (0.50–0.76)], and head position [0.74 (0.63–0.82)]. The FGS scores were not different with [0.075 (0–0.325)] or without [0.088 (0–0.525)] the caregivers' presence (p = 0.12). The FGS is a reliable tool for pain assessment in cats undergoing dental extractions. The caregiver's presence did not affect FGS scores.

Highlights

Oral disease is often observed in veterinary medicine (1)
ICCsingle was moderate for ears, muzzle, whiskers, and head position and good for eyes
This study evaluated the inter-rater reliability of the Feline Grimace Scale (FGS) for pain assessment in cats with naturally occurring oral disease and the effect of the caregiver’s presence on FGS scores

Summary

Introduction

Oral disease is often observed in veterinary medicine (1). Our laboratory revealed that cats with severe oral disease requiring multiple tooth extractions had specific pain-induced behaviors, higher pain scores, changes in serum inflammatory cytokines, and lower food intake when compared with cats with no/minimal oral disease (2, 3). There are three pain scales with validation for feline pain assessment: Glasgow Composite Measure Pain Scale-Feline (CMPS-F) (4), UNESP-Botucatu multidimensional composite pain scale (5) and the recent Feline Grimace Scale (6, 7). These tools have not been used in the context of pain caused by oral disease. Oral pain could be underestimated resulting in delays for analgesic intervention

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