Selected Topics: Prehospital Care| Volume 49, ISSUE 3, P287-293, September 2015

The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales



      Prehospital care (PHC) pain evaluation is an essential patient assessment to be performed by paramedics. Pain intensity is frequently assessed using Verbal Numerical Rating Scale (VNRS) or Visual Analog Scale (VAS).


      Our aim was to evaluate the agreement between VNRS and VAS in measuring acute pain in prehospital setting and to identify the preference among paramedics and patients.


      This was a 3-month cross-sectional study. Convenience sampling was used to enroll patients with acute pain responded to by the ambulance team. Data from consented patients were analyzed using Bland-Altman method, Spearman's correlation test, and Cohen's κ test.


      One hundred and thirty-three patients participated in this study (median age 32 years; 72.2% male). The median for pain score at the scene was 7.50 (interquartile range [IQR]: 5.00) for VAS and 7.00 (IQR: 5.00) for VNRS. The median for pain score on arrival at the hospital was 7.00 (IQR: 3.10) for VAS and 7.00 (IQR: 4.00) for VNRS. There was a strong correlation between VNRS and VAS at the scene (r = 0.865; p < 0.001), as well as on arrival at the hospital (r = 0.933; p < 0.001). Kappa coefficient values and Bland-Altman analysis indicates good agreement between both scales for measuring acute pain. VNRS was the preferred method to measure acute pain by patients and paramedics.


      VAS performs as well as VNRS in assessing acute pain in PHC. VAS and VNRS must not be used interchangeably to assess acute pain; either method should be used consistently.


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