The Verbal Numerical Rating Scale represents a useful clinical tool for the assessment of pain intensity in pediatric patients with painful and nonpainful medical conditions, according to a cross-sectional study published in the Annals of Emergency Medicine.

In this study, investigators asked children (n=733; ages 4-17) with painful and nonpainful conditions to report the severity of pain using the Verbal Numerical Rating Scale and Faces Pain Scale to determine the validity, agreement, and reliability of the scale in the total sample as well as to identify age-stratified subgroups.

The Pearson correlations of validity for the entire patient population, except for ages 4 and 5 years, were strong to very strong (correlation coefficient, 0.80; 95% CI, 0.77-0.82). In addition, agreement between scores on the 2 scales was found to be particularly strong for children age 8 years and older (89.2%; 95% CI, 85.5-92.2), compared with children ages 4 to 7 years (74.9%; 95% CI, 70.2-79.3). Reliability of the Verbal Numerical Rating Scale was also found to be strong in the overall cohort.

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This study was not blinded and involved patients reporting pain intensity directly to a study team member. Thus, patients may have subconsciously reported inaccurate pain severity responses in an effort to align these with the expectations of the researchers.

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Currently, the Verbal Numerical Rating Scale is limited by the patient’s age, primarily because, “age is a reflection of children’s appreciation that numbers are related to quantity, and their possession of necessary abilities such as seriation, quantity estimation, and classification,” concluded the study investigators.

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Tsze DS, von Baeyer CL, Pahalyants V, Dayan PS. Validity and reliability of the verbal numerical rating scale for children aged 4 to 17 years with acute pain [published online October 26, 2017]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2017.09.009