How reliable is pain as the fifth vital sign?
نویسندگان
چکیده
BACKGROUND Although many health care organizations require routine pain screening (eg, "5th vital sign") with the 0 to 10 numeric rating scale (NRS), its accuracy has been questioned; here we evaluated its accuracy and potential causes for error. METHODS We randomly surveyed veterans and reviewed their charts after outpatient encounters at 2 hospitals and 6 affiliated community sites. Using correlation and receiver operating characteristic analysis, we compared the routinely measured "5th vital sign" (nurse-recorded NRS) with a research-administered NRS (research-recorded NRS) and the Brief Pain Inventory (BPI). RESULTS During 528 encounters, nurse-recorded NRS and research-recorded NRS correlated moderately (r = 0.627), as did nurse-recorded NRS and BPI severity scales (r = 0.613 for pain during the last 24 hours and r = 0.588 for pain during the past week). Correlation with BPI interference was lower (r = 0.409). However, the research-recorded NRS correlated substantially with the BPI severity during the past 24 hours (r = 0.870) and BPI severity during the last week (r = 0.840). Receiver operating characteristic analysis showed similar results. Of the 98% of cases where a numeric score was recorded, 51% of patients reported their pain was rated qualitatively, rather than with a 0 to 10 scale, a practice associated with pain underestimation (chi2 = 64.04, P < .001). CONCLUSION Though moderately accurate, the outpatient "5th vital sign" is less accurate than under ideal circumstances. Personalizing assessment is a common clinical practice but may affect the performance of research tools such as the NRS adopted for routine use.
منابع مشابه
Verbal Reports on the Contents of Consciousness Reconsidering Introspectionist Methodology
Doctors must now take a fifth vital sign from their patients: pain reports. I use this as a case study to discuss how different schools of psychology (introspectionism, behaviorism, cognitive psychology) have treated verbal reports about the contents of consciousness. After examining these differences, I suggest that, with new methods of mapping data about neurobiological states with behavioral...
متن کاملThe ‘fifth vital sign’
Pain is one of the most common symptoms, regardless of the specialty in which a patient is being treated. It should be routinely evaluated and recorded in daily clinical examination. In fact, pain has been promulgated as the ‘fifth vital sign’, in addition to the four traditional vital signs of temperature, pulse, blood pressure, and respiratory rate. As well as improving patient comfort and sa...
متن کاملMusculoskeletal Pain- Moving from Symptoms and Syndromes to Mechanisms
Pain is defined by International Association for the Study of Pain 1 as; “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is often considered the fifth vital sign, but often misinterpreted since it is considered mainly subjective. 2 Pain relief is a major goal for health care in India so much that most...
متن کاملAnalgesic Effect of Distraction during Venipuncture in Children with Thalassemia
Background: Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures in children. Distraction is one of the most effective ways to relieve pain. Reducing patients’ pain is important for all nurses for many reasons. Unnecessary pain can damage the nurse-...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of the American Board of Family Medicine : JABFM
دوره 22 3 شماره
صفحات -
تاریخ انتشار 2009