How Reliable is Pain as the Fifth Vital Sign?
How Reliable is Pain as the Fifth Vital Sign?
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DOI：
10.3122/jabfm.2009.03.080162
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发表时间：
2009-05-01
影响因子：
2.9
通讯作者：
Asch, Steven M.
中科院分区：
文献类型：
--
作者：
Lorenz, Karl A.;Sherbourne, Cathy D.;Asch, Steven M.
背景资料：虽然许多医疗机构需要常规的疼痛筛查（如，“第五生命体征”）与0至10的数字评分量表（NRS），其准确性一直受到质疑，在这里，我们评估其准确性和潜在的原因error.Methods：我们随机调查退伍军人，并审查他们的图表后，门诊遇到2家医院和6个附属社区网站。采用相关分析和受试者工作特性分析，比较常规测量的"第五生命体征"（护士记录的NRS）与研究管理的NRS（研究记录的NRS）和简明疼痛量表（BPI）。结果：在528次会面中，护士记录的NRS和研究记录的NRS中度相关（r = 0.627），护士记录的NRS和BPI严重程度量表也是如此（对于过去24小时内的疼痛，r = 0.613;对于过去一周内的疼痛，r = 0.588）。与BPI干扰的相关性较低（r = 0.409）。然而，研究记录的NRS与过去24小时内的BPI严重程度（r = 0.870）和过去一周内的BPI严重程度（r = 0.840）显著相关。受试者操作特征分析显示了类似的结果。在98%的病例中，记录了数字评分，51%的患者报告他们的疼痛是定性评定的，而不是用0到10的量表，这种做法与疼痛低估有关（卡方（2）= 64.04，P <.001）。结论：虽然中等准确，门诊"第五生命体征"是不准确的，比理想情况下。个性化评估是一种常见的临床实践，但可能会影响常规使用的研究工具（如NRS）的性能。（J Am Board Fam Med 2009; 22：291 - 8.）
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 (chi(2) = 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. (J Am Board Fam Med 2009;22:291-8.)