Cut points for mild, moderate, and severe pain on the VAS for children and adolescents: What can be learned from 10 million ANOVAs?
Cut points for mild, moderate, and severe pain on the VAS for children and adolescents: What can be learned from 10 million ANOVAs?
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DOI：
10.1016/j.pain.2013.05.048
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发表时间：
2013-12-01
期刊：
影响因子：
7.4
通讯作者：
Zernikow, Boris
中科院分区：
文献类型：
--
作者：
Hirschfeld, Gerrit;Zernikow, Boris
将疼痛强度分为轻度、中度和重度的切点在疼痛研究和临床实践中被广泛使用。目前，在儿童样本的视觉模拟量表（VAS）中没有一致同意的切点。我们采用了基于Serlin及其同事程序（Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS）的方法。癌痛是轻度、中度还是重度？通过对功能的干扰来划分疼痛的严重程度。疼痛(r) 1995；61:277-84)，以前只用于0到10的数值评定量表，以经验建立VAS的最佳切点（OCs），并使用自举法来估计这些阈值的可变性。我们分析了德国儿童和青少年健康访谈和检查调查（KiGGS）研究的数据，并定义了父母对孩子疼痛的评分和青少年对疼痛强度的自我评分的OCs。分析了2276名儿童（3 - 10岁，54%为女性）和2982名青少年（11 - 17岁，61%为女性）的数据。OCs以毫米为单位进行分析，测试了所有可能的4851种OC组合，截断分析的OCs间隔为5 mm，得到171种OC组合。在按毫米和截断分析中，OC方法确定了父母评分和自我报告的2种不同的OC。当我们估计按毫米分析的可变性时，我们发现特定的oc仅在11%的样本中被发现。然而，截断分析显示，切割点35.60被确定为两个样本的最佳选择，并且是单独切割点的可行替代方案。我们发现了一组分界点，既可以用于父母对孩子痛苦程度的评分，也可以用于青少年的自我报告。采用这些切点大大提高了试验的可比性。我们呼吁对疼痛研究中的诊断程序进行更系统的评估。(C) 2013年国际疼痛研究协会。Elsevier B.V.版权所有。
Cut points that classify pain intensity into mild, moderate, and severe levels are widely used in pain research and clinical practice. At present, there are no agreed-upon cut points for the visual analog scale (VAS) in pediatric samples. We applied a method based on Serlin and colleagues' procedure (Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. PAIN (R) 1995; 61:277-84) that was previously only used for the 0 to 10 numerical rating scale to empirically establish optimal cut points (OCs) for the VAS and used bootstrapping to estimate the variability of these thresholds. We analyzed data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study and defined OCs both for parental ratings of their children's pain and adolescents' self-ratings of pain intensity. Data from 2276 children (3 to 10 years; 54% female) and 2982 adolescents (11 to 17 years; 61% female) were analyzed. OCs were determined in a by-millimeter analysis that tested all possible 4851 OC combinations, and a truncated analysis were OCs were spaced 5 mm apart, resulting in 171 OC combinations. The OC method identified 2 different OCs for parental ratings and self-report, both in the by-millimeter and truncated analyses. When we estimated the variability of the by-millimeter analysis, we found that the specific OCs were only found in 11% of the samples. The truncated analysis revealed, however, that cut points of 35: 60 are identified as optimal in both samples and are a viable alternative to separate cut points. We found a set of cut points that can be used both parental ratings of their children's pain and self-reports for adolescents. Adopting these cut points greatly enhances the comparability of trials. We call for more systematic assessment of diagnostic procedures in pain research. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.