title: The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales.
abstract: BACKGROUND
  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).
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Ahmad K
authors.initials: AK
authors.lastname: Ismail
authors.affiliation: Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Abdul Ghafar
authors.affiliation: Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Noor Shaza A
authors.initials: NS
authors.lastname: Shamsuddin
authors.affiliation: Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Nurul A
authors.initials: NA
authors.lastname: Roslan
authors.affiliation: Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Hilwani
authors.initials: H
authors.lastname: Kaharuddin
authors.affiliation: Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Nik A
authors.initials: NA
authors.lastname: Nik Muhamad
mesh_terms: D059787:Acute Pain / Q000175:diagnosis*; D000328:Adult; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D064232:Visual Analog Scale
keywords: Verbal Numerical Rating Scale; Visual Analog Scale; emergency; pain score; prehospital care