Correlations among visual analog scales, total nasal symptom scores, and peak nasal inspiratory flow in children with perennial allergic rhinitis.

Background: Visual analog scale (VAS) correlates well with total nasal symptom score (TNSS) but negatively correlates with peak nasal inspiratory flow (PNIF) in adults with allergic rhinitis (AR). Small children may not rate VAS properly and parents usually help assess their child's symptoms. Data on the correlations among parent-assessed VAS (P-VAS), VAS, TNSS, and PNIF in children with AR was limited.

Objective: To assess correlations among P-VAS, VAS, TNSS, and PNIF in children and adolescents with perennial AR (PAR).

Methods: Patients with PAR aged 6-18 years and their parents were instructed to record daily VAS, TNSS, PNIF, and P-VAS in an electronic diary for 8 weeks.

Results: 2387 records from 46 patients (56.5% male) were obtained. VAS and P-VAS showed a strong correlation (rs = 0.82, p < 0.001). Moderate correlations were found between VAS vs TNSS (rs = 0.53, p < 0.001) and between P-VAS vs TNSS (rs = 0.48, p < 0.001). There was a weak negative correlation between PNIF vs VAS, PNIF vs TNSS, and PNIF vs P-VAS (rs = -0.20, rs = -0.22, rs = -0.18, p < 0.001 respectively). In addition, a weak negative correlation was found between nasal congestion and PNIF (rs = -0.26, p < 0.001). The overall inter-rater agreement between VAS and TNSS was fair (Kappa = 0.37, p < 0.001). Higher inter-rater agreement was found in moderate-severe than in the mild PAR group (Kappa = 0.50 vs 0.17) and in adolescents than in the children group (Kappa = 0.44 vs 0.26).

Conclusion: In small children, P-VAS was a reliable tool to assess nasal symptoms. Both subjective and objective measurements provided complementary information for symptom monitoring in patients with AR.