The DIRE Score: Predicting outcomes of opioid prescribing for chronic pain
The DIRE Score: Predicting outcomes of opioid prescribing for chronic pain
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DOI：
10.1016/j.jpain.2006.03.001
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发表时间：
2006-09-01
期刊：
影响因子：
4
通讯作者：
Lindgren, Bruce R.
中科院分区：
文献类型：
--
作者：
Belgrade, Miles J.;Schamber, Cassandra D.;Lindgren, Bruce R.
这项回顾性研究的目的是测试临床医生使用的评分工具（DIRE评分）的有效性和可靠性，该工具可预测哪些慢性非癌症疼痛患者将获得有效的镇痛并依从长期阿片类药物维持治疗。DIRE评分分配给疼痛中心数据库中的61例病例。这些病例被抽象为小片段，由6名医生进行审查和评分。2周后对30个小插曲的子集进行重复评分。主要结局指标为：病历和患者治疗临床医生访谈中所示的依从性和疗效的总体印象;最终处置，即在末次临床记录时是否继续或停用阿片类药物。构成DIRE评分的因素的内部一致性很高（Cronbach α =.80）。DIRE评分预测患者依从性的敏感性和特异性分别为94%和87%。对于疗效，敏感性和特异性分别为81%和76%。对于处置，敏感性和特异性分别为86%和73%。组内相关性为0.94为interrater可靠性和0.95为intrarater reliability.Perspective：公众争议使用长期阿片类药物治疗慢性疼痛燃料医生矛盾的处方过程。在这项最初的回顾性研究中，DIRE评分的有效性和可靠性得到了证明。该评分与患者依从性和长期阿片类药物治疗疗效的测量结果相关性良好。(C)2006年，美国疼痛协会。
The objective of this retrospective study was to test the validity and reliability of a scoring tool (the DIRE Score), for use by clinicians, that predicts which chronic noncancer pain patients will have effective analgesia and be compliant with long-term opioid maintenance treatment. DIRE scores were assigned to 61 cases from the pain center's databases. These cases were abstracted into vignettes that were reviewed and scored by 6 physicians. Repeat scoring was carried out on a subset of 30 vignettes after 2 weeks. The main outcome measures were: global impression of compliance and efficacy as indicated in the medical record and by interview with the patient's treating clinician; and final disposition, ie, whether or not opioids were continued or discontinued at the time of last clinical documentation. Internal consistency of the factors making up the DIRE Score was high (Cronbach's alpha =.80). Sensitivity and specificity of the DIRE Score for predicting patient compliance were 94% and 87%, respectively. For efficacy, sensitivity and specificity were 81% and 76%. For disposition, the sensitivity and specificity were 86% and 73%. Intraclass correlation was 0.94 for interrater reliability and 0.95 for intrarater reliability.Perspective: Public controversy about the use of long-term opioids for chronic pain fuels physician ambivalence about the prescribing process. In this initial retrospective study, validity and reliability of the DIRE Score are demonstrated The score correlated well with measures of patient compliance and efficacy of long-term opioid therapy. (C) 2006 by the American Pain Society.