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Validation and properties of the verbal numeric scale in children with acute pain
Benoit Bailey1, Raoul Daoust, Evelyne Doyon-Trottier
1Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montréal, Qc, Canada H3T 1C5 Department of Emergency Medicine, Hôpital du Sacré-Coeur, Université de Montréal, Montreal, Qc, Canada.
Insights
The verbal numeric scale (VNS) is a valid and reliable tool for assessing acute pain in children aged 8-17. While it correlates well with other pain scales, it is not interchangeable with the visual analogue scale (VAS).
Area of Science:
- Pediatric Emergency Medicine
- Pain Assessment
- Clinical Validation
Background:
- The verbal numeric scale (VNS) is widely used for bedside pain assessment but lacks formal validation in pediatric acute pain.
- Assessing acute pain in children is crucial for effective management and requires reliable measurement tools.
Purpose of the Study:
- To formally validate the verbal numeric scale (VNS) for assessing acute pain in children aged 8-17 years.
- To determine the VNS's concurrent validity, construct validity, content validity, interchangeability with the visual analogue scale (VAS), minimal clinically significant difference, and test-retest reliability.
Main Methods:
- A prospective cohort study involving 202 children (8-17 years) presenting to a pediatric emergency department with acute pain.
- Pain was assessed using the VNS, VAS, and verbal rating scale (VRS) at baseline and before discharge.
- Statistical analyses included correlation, comparison of means, and calculation of limits of agreement.
Main Results:
- The VNS demonstrated strong correlation with the VAS (r=0.93, p<0.001), supporting concurrent validity.
- Significant decreases in VNS scores were observed post-intervention (p<0.001), and VNS scores differed across VRS categories (p<0.001), supporting construct and content validity.
- The 95% limits of agreement between VNS and VAS were outside the predefined +/-2.0 limit (-1.8, 2.5), indicating non-interchangeability. The minimal clinically significant difference for VNS was 1, and test-retest reliability was good (-0.9, 1.2).
Conclusions:
- The verbal numeric scale (VNS) is a valid and reliable instrument for evaluating acute pain in children aged 8-17 years.
- While the VNS is a dependable tool for pediatric pain assessment, it should not be used interchangeably with the visual analogue scale (VAS).
Abstract:
Although the verbal numeric scale (VNS) is used frequently at patients' bedsides, it has never been formally validated in children with acute pain. In order to validate this scale, a prospective cohort study was performed in children between 8 and 17years presenting to a pediatric emergency department (ED) with acute pain. Pain was graded using the VNS, the visual analogue scale (VAS), and the verbal rating scale (VRS). A second assessment was done before discharge. We determined a priori that in order to be valid, the VNS would need to: correlate with the VAS (concurrent validity); decrease after intervention to reduce pain (construct validity); and be associated with the VRS categories (content validity). The VNS interchangeability with the VAS, its minimal clinically significant difference, and test-retest reliability were also determined. A total of 202 patients (mean age: 12.2+/-2.6years) were enrolled. The VNS correlated with the VAS: r(ic)=0.93, p<0.001. There were differences in the VNS before versus after interventions (p<0.001), and between VRS categories (mild versus moderate, p<0.001; moderate versus severe, p<0.001). The 95% limits of agreement (interchangeability) between VNS/VAS were outside the a priori set limit of +/-2.0: -1.8, 2.5. The VNS minimal clinically significant difference was 1. The VNS had good test-retest reliability with 95% limits of agreement of -0.9 and 1.2. In conclusion, the VNS provides a valid and reliable scale to evaluate acute pain in children aged 8-17years but is not interchangeable with the VAS.
