Department of Nursing, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia.
Department of Nursing, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Children's Hospital of Eastern Ontario and University of Ottawa, Canada.
J Pediatr Nurs. 2021 Jul-Aug;59:89-95. doi: 10.1016/j.pedn.2021.01.018. Epub 2021 Feb 6.
The Visual Analogue Scale applied by an observer (VASobs) is widely used to quantify pain but the evidence to support validity is poor. The aim of this study was to evaluate the psychometric and practical properties of the VASobs used to assess procedural pain in infants and young children.
In an observational study, 26 clinicians applied the VASobs independently to video segments of 100 children aged six to 42 months undergoing a procedure to generate pain and distress scores. Each video segment was scored by four randomly selected reviewers.
Reliability for pain scores was poor to fair (ICC 0.35 to 0.55) but higher for distress scores (ICC 0.6 to 0.89). At a cut-off score of 3, sensitivity and specificity were 84.7% and 95.0%, respectively for pain and 91.5% and 77.5% respectively for distress. Linear mixed modelling confirmed responsiveness. An increase in pain scores (regression slope 4.95) and distress scores (regression slope 5.52) across phases (baseline to procedure) was seen for painful procedures. The correlation between VASobs pain and FLACC scores was good (r = 0.74) and correlations between VASobs distress and FLACC scores were excellent (r = 0.89).
VASobs was easily applied and preferred by clinicians. Despite evidence of sensitivity and responsiveness to pain, the reliability results were poor, and this scale cannot be recommended for use.
The results of this study prevent recommending the VASobs for assessing procedural pain in infants and young children for clinical or research purposes.
观察者使用的视觉模拟评分（VASobs）被广泛用于量化疼痛，但支持其有效性的证据很少。本研究旨在评估 VASobs 用于评估婴儿和幼儿手术疼痛的心理测量学和实际特性。
在一项观察性研究中，26 名临床医生独立地对 100 名 6 至 42 个月大的儿童进行手术的视频片段进行 VASobs 评估，以生成疼痛和不适评分。每个视频片段由随机选择的四名评审者进行评分。
疼痛评分的可靠性为差到尚可（ICC 0.35 至 0.55），但不适评分的可靠性更高（ICC 0.6 至 0.89）。在 3 分的截断分数下，疼痛的灵敏度和特异性分别为 84.7%和 95.0%，不适的灵敏度和特异性分别为 91.5%和 77.5%。线性混合模型证实了其反应能力。在疼痛程序中，疼痛评分（回归斜率 4.95）和不适评分（回归斜率 5.52）在各阶段（基线至手术）均呈线性增加。VASobs 疼痛评分与 FLACC 评分之间的相关性良好（r=0.74），VASobs 不适评分与 FLACC 评分之间的相关性极好（r=0.89）。
VASobs 易于应用，且受到临床医生的青睐。尽管有证据表明对疼痛具有敏感性和反应性，但可靠性结果较差，因此不建议将该量表用于评估婴儿和幼儿的手术疼痛。
本研究的结果阻止了 VASobs 用于评估婴儿和幼儿手术疼痛的临床或研究目的。
