Table 4 Summary of key evidence to support response scale selection for children 6 to 18 years old

Benini et al. 2004 [17], Direct, A

Prospective Study; Children aged 7 to 18 years old

Graphical scales; VAS

In developmentally delayed children 7 to 18 years, the VAS scale was the easiest to use and understand, however, ratings were affected by emotions of participants (fear). The color scale was difficult for the children to understand, use and had difficulty interpreting Faces scales which includes an emotional overlay.

van Laerhoven et al. 2004 [12], Direct, A

Cross-Sectional Study; Children aged 6 to 18 years old

NRS; VAS; VRS

Children 6 to 18 years preferred the VRS over the NRS and VAS and find it easiest to complete. The VRS scale, the VAS and the NRS were of comparable reliability.

Jylli et al. 2006 [13], Direct, C

Cross-Sectional Study; Children aged 6 to 16 years old

VAS; VRS

Children 6 to 11 years knew fewer words than children 12 to 16 years to describe pain. Further studies are needed to determine the suitability of using 5-point VRS with word descriptors of pain with children of all ages. The study showed a weak correlation between the pain-rating index quotient for the sensory VRS and the VAS in the entire group.

Bailey et al. 2007 [16], Direct, A

Cross-Sectional Study; Children aged 8 to 18 years old

Graphical scales; NRS; VAS

Only the VAS and the VAS color analogue scale have acceptable agreement in children 8 to 18 years with moderate to severe acute abdominal pain. In particular, the NRS is not in agreement with the other evaluated scales and is not recommended for use in this population.

Bailey et al. 2010 [14], Direct, A

Prospective Study; Children aged 8 to 17 years old

NRS; VAS

The NRS provides a valid and reliable scale to evaluate acute pain in children aged 8–17 years but is not interchangeable with the VAS.

Connelly and Neville 2010 [15], Direct, A

Prospective Study; Children aged 9 to 18 years old

Faces scales; NRS; VAS

Results showed that in children 9 to 18 years, all 3 pain-intensity measures (Faces, VAS, and NRS) were highly interrelated, varied similarly with age and baseline state anxiety, and were comparably related to contemporaneous changes in affect. However, patients tended to rate pain intensity higher on the NRS, and the VAS and Faces Pain Scale-Revised were more responsive to decreasing trends in pain scores with elapsed surgical recovery time than the NRS.