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Determining the minimum clinically significant difference in visual analog pain score for children
C V Powell1, A M Kelly, A Williams
1Department of Emergency Medicine, Sunshine Hospital, Melbourne, Australia.
Insights
The minimum clinically significant difference in visual analog scale (VAS) pain score for children aged 8-15 is 10 mm. This finding helps determine if pain score changes are meaningful in clinical practice.
Area of Science:
- Pediatric Emergency Medicine
- Pain Assessment
- Clinical Significance
Background:
- Assessing pain in children is crucial for effective treatment.
- The visual analog scale (VAS) is a common tool for pain measurement.
- Defining a minimum clinically significant difference (MCSD) is essential for interpreting VAS scores.
Purpose of the Study:
- To determine the MCSD in VAS pain scores for children aged 8 to 15 years.
- To establish a benchmark for clinically meaningful pain reduction in pediatric patients.
Main Methods:
- Prospective, repeated-measures study in a pediatric emergency department.
- Children (8-15 years) with acute pain used a 100-mm VAS and provided verbal pain ratings.
- MCSD defined as the mean VAS change when patients reported pain as 'a bit better' or 'a bit worse'.
Main Results:
- 103 evaluable comparisons from 73 children were analyzed.
- The MCSD in VAS pain score was found to be 10 mm.
- The 95% confidence interval for the MCSD was 7 to 12 mm.
Conclusions:
- A 10-mm change on the 100-mm VAS represents the minimum clinically significant difference for children aged 8-15.
- Statistically significant VAS changes smaller than 10 mm may not be clinically relevant in pediatric populations.
Study Objective:
We sought to determine the minimum clinically significant difference in visual analog scale (VAS) pain score for children.
Methods:
We performed a prospective, single-group, repeated-measures study of children between 8 and 15 years presenting to an urban pediatric emergency department with acute pain. On presentation to the ED, patients marked the level of their pain on a 100-mm nonhatched VAS scale. At 20-minute intervals thereafter, they were asked to give a verbal categoric rating of their pain as "heaps better," "a bit better," "much the same," "a bit worse," or "heaps worse" and to mark the level of pain on a VAS scale of the same type as used previously. A maximum of 3 comparisons was recorded for each child. The minimum clinically significant difference in VAS pain score was defined as the mean difference between current and preceding scores when the subject reported "a bit worse" or "a bit better" pain.
Results:
Seventy-three children were enrolled in the study, yielding 103 evaluable comparisons in which pain was rated as "a bit better" or "a bit worse." The minimum clinically significant difference in VAS score was 10 mm (95% confidence interval 7 to 12 mm).
Conclusion:
This study found the minimum clinically significant difference in VAS pain score for children aged 8 to 15 years (on a 100-mm VAS scale) to be 10 mm (95% confidence interval 7 to 12 mm). In studies of populations, differences of less than this amount, even if statistically significant, are unlikely to be of clinical significance.