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Visual Analog Scale: A Suitable Method for Assessing Voiding Dysfunction?

Monday, October 22, 2012: 9:36 AM
Grand Ballroom B (Hilton Riverside)
Ruiyang Jiang, Karen Pritzker, Anjana Shah, Janelle Traylor and Nicol Bush, Pediatric Urology, Children's Medical Center Dallas, Dallas, TX

Purpose: The Vancouver Symptom Score (VSS) is one tool for diagnosing bowel and bladder dysfunction (BBD). However, in clinical practice, it can be time-constraining for the parents to fill out and for the provider to calculate scores. The Visual Analog Scale (VAS) is a validated, quick and reliable tool used to determine the degree of bother for numerous conditions. Our goal was to determine if the VAS was useful for assessing BBD symptoms.

Methods: Patients referred to our BBD clinic were assessed using both the VSS and VAS, completed by the parent at initial evaluation and follow up. In addition, the child completed a separate VAS. The VSS is a 14-item 5-point Likert scale questionnaire (range 0-52), demonstrating 80% diagnostic accuracy for BBD (Afshar et al, JUrol 2009). In comparison, the VAS is a linear scale with scores ranging from 0-100, corresponding to the marked line (Fig 1). Analyses were performed with Spearman's correlation and Mann Whitney U.

Results: Among 363 consecutive patients presenting to the BBD clinic (female = 227; mean age = 8.4 years), 334 completed VVS and VAS. Follow-up VAS and VVS scores were available in 243 patients. Parent VAS and VSS scores were significantly correlated (r=0.48, p<0.0001). Likewise, child VAS and VSS scores were positively correlated, although with a decreased relationship trend (r=0.30, p<0.0001). Follow-up VAS and VSS scores were similarly correlated (p<0.0001), such that 58 patients with unchanged or worse VSS scores had significantly worse VAS bother scores (mean 7.5-point worsening, SD 9.99, p<0.0001) compared to 185 patients with improved VSS scores, who demonstrated mean 29.6-point improvement (SD 34.28, p<0.0001).

Conclusion: VAS bother scores provide a simple, quick method of assessing and following global symptoms of BBD. Both parental and child-rated VAS scores positively correlated with the VSS on initial and follow-up visits. Mean VAS bother scores worsened with unchanged or worse VSS scores, and improved nearly 30% among those whose VSS scores improved.

Figure 1. Example of Visual Analog Scale.