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Validity and Reliability of the Verbal Numerical Rating Scale for Children Aged 4 to 17 Years With Acute Pain
Daniel S Tsze1, Carl L von Baeyer2, Vartan Pahalyants1
1Department of Pediatrics, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Insights
The Verbal Numerical Rating Scale is valid and reliable for children aged 6 and older. However, its convergent validity is weak in younger children aged 4 and 5 years.
Area of Science:
- Pediatric Pain Management
- Psychometrics in Children
- Clinical Assessment Tools
Background:
- The Verbal Numerical Rating Scale (VNRS) is a widely used tool for assessing pain intensity.
- Limited data exists on the VNRS's validity and reliability across different age groups in pediatric populations.
- Understanding age-specific performance is crucial for accurate pain assessment in children.
Purpose of the Study:
- To evaluate the validity and reliability of the VNRS in children aged 4-17 presenting to the emergency department.
- To determine age-specific performance characteristics of the VNRS.
Main Methods:
- A cross-sectional study involving 760 children (aged 4-17) who self-reported pain using VNRS and Faces Pain Scale-Revised.
- Assessed convergent validity, agreement, known-groups validity, responsivity, and reliability.
- Analyzed data in the total sample and age-stratified subgroups.
Main Results:
- VNRS showed strong convergent validity (correlation coefficient ≥0.60) for children aged 6-17 years.
- Agreement was strong for children aged 8 years and older.
- Known-groups validity and responsivity were strong across all ages.
- Reliability was strong in all age subgroups, including 4-7 years.
Conclusions:
- The VNRS is a valid and reliable pain intensity measure for children aged 6 years and older.
- VNRS convergent validity is not robust for children aged 4 and 5 years.
- Clinical use of VNRS is supported for children aged 6+, with caution for younger age groups.
Study Objective:
The Verbal Numerical Rating Scale is the most commonly used self-report measure of pain intensity. It is unclear how the validity and reliability of the scale scores vary across children's ages. We aimed to determine the validity and reliability of the scale for children presenting to the emergency department across a comprehensive spectrum of age.
Methods:
This was a cross-sectional study of children aged 4 to 17 years. Children self-reported their pain intensity, using the Verbal Numerical Rating Scale and Faces Pain Scale-Revised at 2 serial assessments. We evaluated convergent validity (strong validity defined as correlation coefficient ≥0.60), agreement (difference between concurrent Verbal Numerical Rating Scale and Faces Pain Scale-Revised scores), known-groups validity (difference in score between children with painful versus nonpainful conditions), responsivity (decrease in score after analgesic administration), and reliability (test-retest at 2 serial assessments) in the total sample and subgroups based on age.
Results:
We enrolled 760 children; 27 did not understand the Verbal Numerical Rating Scale and were removed. Of the remainder, Pearson correlations were strong to very strong (0.62 to 0.96) in all years of age except 4 and 5 years, and agreement was strong for children aged 8 and older. Known-groups validity and responsivity were strong in all years of age. Reliability was strong in all age subgroups, including each year of age from 4 to 7 years.
Conclusion:
Convergent validity, known-groups validity, responsivity, and reliability of the Verbal Numerical Rating Scale were strong for children aged 6 to 17 years. Convergent validity was not strong for children aged 4 and 5 years. Our findings support the use of the Verbal Numerical Rating Scale for most children aged 6 years and older, but not for those aged 4 and 5 years.
