Comparison of three acute colic pain scales: Reliability, validity and usability.
Authors: Sutton G A, Atamna R, Steinman A, Mair T S
Journal: Veterinary journal (London, England : 1997)
Summary
# Editorial Summary: Comparing Colic Pain Assessment Scales Accurate, reproducible pain scoring is essential for clinical decision-making in acute equine colic, yet no consensus exists on the optimal assessment method. Sutton and colleagues evaluated three commonly-used pain scales—the equine acute abdominal pain scale (EAAPS), the Mair and Smith scale, and a numerical rating scale—by having 46 veterinarians from various countries score video recordings of 40 horses (35 with colic, 5 controls), with repeat assessments to measure consistency. The EAAPS demonstrated substantially superior inter-observer reliability (ICC 0.86) compared to both the Mair and Smith scale (0.68) and the NRS (0.71), and showed notably better intra-observer reliability (weighted κ 0.95 versus 0.78 and 0.77 respectively), meaning individual assessors using the EAAPS were more likely to score the same horse consistently. Whilst the Mair and Smith scale earned higher marks for face validity—suggesting it felt more clinically intuitive to experts—all three scales performed equivalently on other validity measures and required similar assessment time, making the EAAPS the preferred choice for standardised, reliable colic pain evaluation in practice and research settings.
Read the full abstract on PubMed
Practical Takeaways
- •If you need the most consistent and reproducible pain assessment tool, use the EAAPS—it shows the best reliability both within and between observers evaluating the same cases
- •The M and S scale may be preferred by clinicians for its intuitive design, but be aware it has lower reliability; consider EAAPS if consistency across your clinic or research is critical
- •All three scales perform similarly in speed and usability, so choice can be based on local preference and reliability needs rather than workflow concerns
Key Findings
- •EAAPS demonstrated superior inter-observer reliability (ICC 0.86) compared to M and S scale (0.68) and NRS (0.71)
- •EAAPS intra-observer reliability was significantly better (weighted κ 0.95) than M and S (0.78) and NRS (0.77)
- •M and S scale had better face validity endorsement by expert veterinarians than EAAPS
- •No significant differences found between scales in convergent validity, extreme group validity, predictive validity, speed of use, or ease of use