Comparison of different pain scoring systems in critically ill patients in a general ICU.
Comparison of different pain scoring systems in critically ill patients in a general ICU.
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DOI：
10.1186/cc6789
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Knibbe CA
中科院分区：
文献类型：
--
作者：
Ahlers SJ;van Gulik L;van der Veen AM;van Dongen HP;Bruins P;Belitser SV;de Boer A;Tibboel D;Knibbe CA
重症监护室（ICU）中的危重患者疼痛很常见。然而，危重患者的疼痛评估往往是复杂的，因为这些患者无法有效地沟通。因此，我们设计了一项研究（a）确定数字评定量表（NRS）和行为疼痛量表（BPS）的评分者间可靠性，（B）比较不同观察者和患者的疼痛评分，（c）比较NRS、BPS和视觉模拟量表（VAS）用于测量ICU患者的疼痛。我们对113例非瘫痪重症患者进行了前瞻性观察研究。主治护士、两名研究人员和患者（如可能）获得了371个独立的NRS、BPS和VAS观察系列。对患者样本量（n = 113）进行数据分析。NRS和BPS的评定者间可靠性被证明是足够的（kappa分别= 0.71和0.67）。由患者评定的NRS与由主治护士评定的NRS在一个量表点内的一致性水平为73%。然而，护士低估了高患者评分（NRS ≥4）（患者33%，护士18%）。在有反应的患者中，NRS与VAS高度相关（rs = 0.84，P < 0.001）。机械通气组NRS与BPS呈中度正相关（rs = 0.55，P < 0.001）。然而，尽管6%的观察结果为NRS ≥ 4，但BPS评分均非常低（中位数3.0，范围3.0 - 5.0）。不同的量表显示出较高的可靠性，但基于神经元的评估往往低估了疼痛，特别是在患者评定的高NRS值（≥4）的情况下。因此，只要有可能，ICU患者应该对他们的疼痛进行评分。在无反应的患者中，主要是参与日常护理的主治护士应该对患者的疼痛进行评分。对于通气患者，BPS应仅与NRS护士配合使用，以在没有疼痛刺激的情况下测量疼痛水平。
Pain in critically ill patients in the intensive care unit (ICU) is common. However, pain assessment in critically ill patients often is complicated because these patients are unable to communicate effectively. Therefore, we designed a study (a) to determine the inter-rater reliability of the Numerical Rating Scale (NRS) and the Behavioral Pain Scale (BPS), (b) to compare pain scores of different observers and the patient, and (c) to compare NRS, BPS, and the Visual Analog Scale (VAS) for measuring pain in patients in the ICU. We performed a prospective observational study in 113 non-paralyzed critically ill patients. The attending nurses, two researchers, and the patient (when possible) obtained 371 independent observation series of NRS, BPS, and VAS. Data analyses were performed on the sample size of patients (n = 113). Inter-rater reliability of the NRS and BPS proved to be adequate (kappa = 0.71 and 0.67, respectively). The level of agreement within one scale point between NRS rated by the patient and NRS scored by attending nurses was 73%. However, high patient scores (NRS ≥4) were underestimated by nurses (patients 33% versus nurses 18%). In responsive patients, a high correlation between NRS and VAS was found (rs = 0.84, P < 0.001). In ventilated patients, a moderate positive correlation was found between the NRS and the BPS (rs = 0.55, P < 0.001). However, whereas 6% of the observations were NRS of greater than or equal to 4, BPS scores were all very low (median 3.0, range 3.0 to 5.0). The different scales show a high reliability, but observer-based evaluation often underestimates the pain, particularly in the case of high NRS values (≥4) rated by the patient. Therefore, whenever this is possible, ICU patients should rate their pain. In unresponsive patients, primarily the attending nurse involved in daily care should score the patient's pain. In ventilated patients, the BPS should be used only in conjunction with the NRS nurse to measure pain levels in the absence of painful stimuli.
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7.4
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