![]() There are similar studies in other populations, among them orthopedic patients and cancer patients. The results of this study do not establish that the method is equal in all populations. Earlier studies establish a consensus that NRS is easier to perform than VAS ( 2, 9). We have not examined which method is the better, only whether the two methods produce equal results. We do only present a single time point and the data cannot tell of changes in VAS versus NRS over time. All patients were presented to NRS before VAS, where the triage nurse collected NRS-value while the VAS-value was collected by two medical students. Collection of oral informed consent creates an emphasis on the fact that this is a study, with risk of patients attempting to answer the same. Presenting VAS short time after NRS may introduce a bias. The data collection was in daytime and evening in an un-selected patient group to ensure a more representative material. The strength of this study is that pain was reported by VAS short time after NRS by standardized questions in such a way that the information to the patient group was the same. Kruskal-Wallis test was used for the subgroup analyses between VAS and NRS for gender (female/male), age (over/under 30 years old), triage (green/yellow/orange) and general department affiliation (surgery/medicine) We utilized Spearman correlation coefficient and Bland-Altman plot to study correlation and agreement between VAS and NRS value. The collected data were organized in MS Excel, then analyzed in SPSS v2.5. A priori acceptable clinical difference between the scores were defined to a maximum of +/-1, based on repeatability of test-retest of VAS ( 1). We predefined a null hypothesis of no significant difference between VAS and NRS value. The procedure of inclusion was made in agreement with the Data Protection Officer of the Hospital and the Regional Ethics Board of Western Norway. The patient information was anonymized immediately after inclusion. We have in our study design refrained from written informed consent to reduce the amount of registered personal information. The study included patients after informed oral consent. Exclusion criteria were age under 18 years, lack of competence to consent, cognitive failure as well as lack of lingual or motor skills. 200 unselected patients with pain were included, no clinical groups of patients were excluded. We made a general estimation in advance on the number of patients to include, based on presumed sufficient material and a general achivable number. The target population were patients with pain in triage in the Emergency Department. The following variables were registered on paper: VAS, NRS, gender, age, triage and general department affiliation. We transcribed the value in mm and converted to the closest integer (0-10). The patient graded their pain with a moveable plastic marker to their pain level. We used a horizontal VAS-ruler (0-100 mm) with the endpoints “no pain” to the left and “worst thinkable pain” to the right. After oral approval, the patient was again scored with VAS. After the nurse had finished the triage, the patients were asked to participate in a study. The nurse asked the patient to grade their pain with an integer between 0 and 10, where 0 is no pain and 10 is the worst thinkable pain. As a part of the primary triage at admission, the nurse collected pain score by use of NRS. We performed a cross-sectional study of pain in primary triage registration at the emergency department at Haukeland University Hospital in the period June to August 2019. The objective of this study was to examine correlation and agreement between VAS and NRS score in patients admitted with pain to an emergency department in Norway. Some studies show good agreement between methods ( 1, 6) while others find a larger discrepancy ( 5, 7, 8). Several studies have shown a strong statistical correlation between VAS and NRS scores ( 1, 5, 6, 7). In the clinic, the terms are often used as interchangeable, and NRS is in general noted as VAS ( 4). Both methods are much used in clinical practice and research ( 3). NRS is a verbal numeric scale, where the patient grades their own pain on a scale between 0 and 10. Using VAS, the patient defines the degree of pain on a visual scale without numeric values, while the values are visible on the back side for the registrar. There are several validated tools to rate pain, as Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) ( 2, 3). Pain score is a part of defining the degree of urgency of diagnostics and treatment, and is important for evaluating the effect of treatment. Pain is a subjective sensation, which is important to quantify in a clinical setting ( 1, 2).
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