Prospective validation of clinically important changes in pain severity measured on a visual analog scale
Prospective validation of clinically important changes in pain severity measured on a visual analog scale
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DOI：
10.1067/mem.2001.118863
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发表时间：
2001-12-01
影响因子：
6.2
通讯作者：
Bijur, PE
中科院分区：
文献类型：
--
作者：
Gallagher, EJ;Liebman, M;Bijur, PE
背景：在一项具有里程碑意义的假说生成研究中，Todd等人发现，在一组创伤患者中，视觉模拟评分(VAS)上大约13 mm(95%可信区间[CI]10至17 mm)的差异代表了在创伤患者队列中具有临床意义的急性疼痛的最小变化。研究目的：我们在一个独立的、更不同的验证队列中测试VAS测量的疼痛最小临床显著变化约为13 mm的假设。方法：这是一项前瞻性的观察性队列研究，研究对象是向2个城市急诊疼痛患者就诊的成年人。在两个小时内，患者每隔30分钟标记一次VAS，并被问及他们的疼痛是“少得多”、“少一点”、“差不多”、“多一点”还是“多得多”。所有数据都是在没有参考先前VAS评分的情况下获得的。疼痛的最小临床显著变化被定义为先验的，即当报告“稍微多一点”或“稍微少一点”时，当前和紧接着之前的VAS评分之间的毫米差。结果：96名患者参与研究，提供332对疼痛测量。有141项配对测量结果被患者指定为“稍微减轻”或“稍微加重”疼痛。在“少一点”或“多一点”组合组中，连续疼痛分级之间的平均临床显著差异为13 mm(95%可信区间为10至16 mm)。这一发现与Todd等人的发现之间的差异为0 mm(95%CI-4到4 mm)。结论：这些数据几乎与先前的发现相同，即VAS上13 mm的差异平均代表着临床上有意义的急性疼痛的最小变化。
Background: In a landmark hypothesis-generating study, Todd et al found that a difference of approximately 13 mm (95% confidence interval [CI] 10 to 17 mm) on a visual analog scale (VAS) represented the minimum change in acute pain that was clinically significant in a cohort of trauma patients.Study objective: We test the hypothesis that the minimum clinically significant change in pain as measured by the VAS in an independent, more heterogeneous validation cohort is approximately 13 mm.Methods: This was a prospective, observational cohort study of adults presenting to 2 urban emergency departments with pain. At 30-minute intervals during a 2-hour period, patients marked a VAS and were asked if their pain was "much less," "a little less," "about the same," "a little more," or "much more." All data were obtained without reference to prior VAS scores. The minimum clinically significant change in pain was defined a priori as the difference in millimeters between the current and immediately preceding VAS scores when "a little more" or "a little less pain" was reported.Results: Ninety-six patients enrolled in the study, providing 332 paired pain measurements. There were 141 paired measurements designated by patients as "a little less" or "a little more" pain. The mean clinically significant difference between consecutive ratings of pain in the combined "little less" or "little more" groups was 13 mm (95% CI 10 to 16 mm). The difference between this finding and that of Todd et al was 0 mm (95% CI -4 to 4 mm).Conclusion: These data are virtually identical to previous findings indicating that a difference of 13 mm on a VAS represents, on average, the minimum change in acute pain that is clinically significant.