Bailey Benoit, Bergeron Sylvie, Gravel Jocelyn, Daoust Raoul
Division of Emergency Medicine, Hôpital du Sacré-Coeur, Montreal, Quebec, Canada.
Ann Emerg Med. 2007 Oct;50(4):379-83, 383.e1-2. doi: 10.1016/j.annemergmed.2007.04.021. Epub 2007 Jun 22.
In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED).
Participants were children who were aged 8 to 18 years, presented to a pediatric ED with abdominal pain suggestive of appendicitis, and were recruited to participate in a randomized controlled trial evaluating the efficacy of morphine. Patients were initially asked to grade their pain on a plasticized color analog scale, a paper visual analog scale, a paper Wong-Baker FACES Pain Rating Scale, and then with a verbal numeric scale. Thirty minutes after morphine or placebo administration, the assessment was repeated. All scores were then converted to a value of 0 to 100. Agreements between scores were evaluated with the Bland-Altman method, and the 95% lower and upper limits were reported. We defined a priori the maximum limit of agreement at +/-20 mm.
A total of 87 children were included in the study, 58 of them with confirmed appendicitis. The 95% limits of agreement for each pair of scales were visual analog scale/color analog scale -18.6, 14.4; visual analog scale/Wong-Baker FACES Pain Rating Scale -20.1, 33.7; visual analog scale/verbal numeric scale -30.2, 20.7; color analog scale/Wong-Baker FACES Pain Rating Scale -18.5, 36.3; color analog scale/verbal numeric scale -26.9, 22.1; and Wong-Baker FACES Pain Rating Scale/verbal numeric scale -38.7, 15.7.
Our study suggests that only the visual analog scale and the color analog scale have acceptable agreement in children with moderate to severe acute abdominal pain. In particular, the verbal numeric scale is not in agreement with the other evaluated scales.
在儿童中，用于记录疼痛强度的众多量表之间的一致性尚不清楚。因此，为了确定这种一致性，我们在儿科急诊科（ED）对疑似阑尾炎的急性腹痛儿童，评估了视觉模拟量表、标准化颜色模拟量表、面部表情疼痛评分量表（Wong-Baker FACES Pain Rating Scale）和言语数字量表。
参与者为8至18岁的儿童，因疑似阑尾炎的腹痛就诊于儿科急诊科，并被招募参加一项评估吗啡疗效的随机对照试验。最初要求患者在塑料颜色模拟量表、纸质视觉模拟量表、纸质面部表情疼痛评分量表上对自己的疼痛进行评分，然后再用言语数字量表评分。在给予吗啡或安慰剂30分钟后，重复评估。然后将所有分数转换为0至100的值。用Bland-Altman方法评估分数之间的一致性，并报告95%的下限和上限。我们预先定义一致性的最大界限为±20mm。
共有87名儿童纳入研究，其中58名确诊为阑尾炎。每对量表的95%一致性界限为：视觉模拟量表/颜色模拟量表 -18.6，14.4；视觉模拟量表/面部表情疼痛评分量表 -20.1，33.7；视觉模拟量表/言语数字量表 -30.2，20.7；颜色模拟量表/面部表情疼痛评分量表 -18.5，36.3；颜色模拟量表/言语数字量表 -26.9，22.1；面部表情疼痛评分量表/言语数字量表 -38.7，15.7。
我们的研究表明，在中度至重度急性腹痛儿童中，只有视觉模拟量表和颜色模拟量表具有可接受的一致性。特别是，言语数字量表与其他评估量表不一致。
