Monitoring acute equine visceral pain with the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP): A scale-construction study.
Authors: van Loon Johannes P A M, Van Dierendonck Machteld C
Journal: Veterinary journal (London, England : 1997)
Summary
# Editorial Summary: EQUUS-COMPASS and EQUUS-FAP Pain Assessment Scales Whilst equine pain recognition has received considerable research attention, clinicians lack reliable objective tools for assessing acute colic—a condition where rapid, accurate pain quantification directly influences treatment decisions. Van Loon and Van Dierendonck developed two complementary assessment scales: the EQUUS-COMPASS (a composite behavioural tool) and EQUUS-FAP (a facial expression-specific scale), testing both on 25 colic cases and 25 healthy controls at presentation and on subsequent days. Both scales demonstrated excellent inter-observer reliability (ICC = 0.98 and 0.93 respectively, significantly outperforming traditional Visual Analogue Scale scoring at ICC = 0.63), with the EQUUS-COMPASS achieving 95.8% sensitivity and 84.0% specificity for identifying pain, whilst the EQUUS-FAP achieved 87.5% sensitivity and 88.0% specificity. Established cut-off scores enabled clinicians to distinguish healthy horses from colic patients and, critically, to differentiate conservative cases from those requiring surgery or euthanasia—offering quantifiable, repeatable pain assessment that could standardise decision-making in acute colic management and reduce observer bias in both clinical and research settings.
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Practical Takeaways
- •These validated pain assessment scales provide objective, reliable tools for evaluating colic severity and monitoring treatment response in clinical practice
- •The EQUUS-COMPASS composite scoring system offers high sensitivity and specificity for identifying horses requiring surgical intervention or euthanasia, aiding clinical decision-making
- •Using facial assessment (EQUUS-FAP) provides a quick, observer-reliable method to quantify pain without extensive behavioral observation
Key Findings
- •EQUUS-COMPASS and EQUUS-FAP scales demonstrated high inter-observer reliability (ICC = 0.98 and 0.93 respectively, P < 0.001)
- •EQUUS-COMPASS cut-off value of 5 differentiated healthy from colic horses with 95.8% sensitivity and 84.0% specificity
- •EQUUS-FAP cut-off value of 4 achieved 87.5% sensitivity and 88.0% specificity for healthy vs. colic differentiation
- •Both scales enable repeated objective pain assessment in acute equine colic, superior to Visual Analog Scale (ICC = 0.63)