Self‐reported Pain Scores in the Emergency Department: Lack of Association with Vital Signs

Marco, Catherine A.; Plewa, Michael C.; Buderer, Nancy; Hymel, Gregory; Cooper, Jeffrey S.

doi:10.1197/j.aem.2006.04.015

Cited by 50 publications

(23 citation statements)

References 37 publications

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“…Our results are similar to those of other studies in ED, prehospital, or military settings. 25,28,36,37,39 For example, Bendall et al demonstrated, in a retrospective prehospital study, a slightly increased likelihood of severe pain if: HR is ≥100 beats/min for patients ≤ 64 years old, or if SBP was ≥140 mm Hg for patients ≥65 years old (18% and 14%, respectively). However, these authors concluded: "Simple correlation fails to show clinically important association between prehospital vital signs and pain severity."…”

Section: Discussionmentioning

confidence: 99%

“…However, in the prehospital and ED literature, it is unclear how useful vital signs are for predicting pain intensity. [22][23][24][25][26][27][28][29][30] Pain intensity is subjective, and with conflicting results, researchers have tried to identify unbiased parameters (including vital signs) to validate pain intensity. HR (or HR variability), more than blood pressure, has been associated with pain intensity, [22][23][24]27,[31][32][33][34] but mostly in males.…”

Section: Introductionmentioning

confidence: 99%

“…24,26 However, as was the case for HR, other investigations reported an absence of relationship. 28,33,35,39 Most studies have failed to show an association between pain and respiratory rate. 22,24,26,28,31,33,37,39 Transcutaneous oxygen, skin conductance, and the analgesia/nociception index (calculated from HR variability) have been assessed in patients experiencing pain with inconsistent conclusions.…”

Section: Introductionmentioning

confidence: 99%

“…28,33,35,39 Most studies have failed to show an association between pain and respiratory rate. 22,24,26,28,31,33,37,39 Transcutaneous oxygen, skin conductance, and the analgesia/nociception index (calculated from HR variability) have been assessed in patients experiencing pain with inconsistent conclusions. 23,27,31,32,34,38,[40][41][42] Patients with severe pain who show no hypertension or tachycardia to substantiate their pain intensity might not receive the aggressive pain treatment they warrant.…”

Section: Introductionmentioning

confidence: 99%

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Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Daoust

Paquet

Bailey

et al. 2015

CJEM

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Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain. Methods: We performed a retrospective analysis of real-time, archived data from an electronic medical record system at an urban teaching hospital and regional community hospital. We included consecutive ED patients ≥16 years old who had a self-reported pain intensity ≥1 as measured during triage, from March 2005 to December 2012. The primary outcome was vital signs for self-reported pain intensity levels (mild, moderate, severe) on an 11-point verbal numerical scale. Changes in pain intensity levels were also compared to variations in vital signs. Both analyses were repeated on a subgroup of patients with diagnosed conditions recognized to produce significant pain: fracture, dislocation, or renal colic. Results: We included 153,567 patients (mean age of 48.4 ± 19.3 years; 55.5% women) triaged with pain (median intensity of 7/10 ± 3). Of these, 8.9% of patients had diagnosed conditions recognized to produce significant pain. From the total sample, the difference between mild and severe pain categories was 2.7 beats/minutes (95% CI: 2.4 − 3.0) for heart rate and 0.13 mm Hg (95% CI: -0.26 − 0.52) for systolic blood pressure. These differences generated small effect sizes and were not clinically significant. Results were similar for patients who experienced changes in pain categories and for those conditions recognized to produce significant pain. Conclusion: Health care professionals cannot use vital signs to estimate or substantiate self-reported pain intensity levels or changes over time. RÉSUMÉObjectif: L'étude visait à confirmer l'existence d'une association entre l'intensité de la douleur autodéclarée et les signes vitaux enregistrés chez des patients au service des urgences (SU) ainsi que dans un sous-groupe de malades souffrant d'affections connues pour causer de fortes douleurs. Méthode: Les auteurs ont procédé à une analyse rétro-spective de données enregistrées en temps réel et archivées dans un système de dossiers médicaux électroniques, dans un centre hospitalier universitaire urbain et dans un hôpital communautaire régional. Ont participé à l'étude des patients consécutifs, âgés de ≥16 ans, qui ont fait état, au SU, de douleurs d'une intensité ≥1, mesurée durant le triage, de mars 2005 à décembre 2012. Le principal critère d'évaluation était les signes vitaux associés à différents degrés d'intensité (légère, modérée, forte) de la douleur autodéclarée sur une échelle numérique, verbale, de 11 points. Les variations de l'intensité de la douleur ont également été comparées aux variations des signes vitaux. Les deux analyses ont été reprises dans un sous-groupe de patients souffrant d'affections connues pour causer de fortes douleurs: fracture, luxation ou colique néphrétique. Résultats: Ont participé à l'étude 153 567 patients (âge moyen: 48,4 ± 19,3 ans; femm...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Daoust

Paquet

Bailey

et al. 2015

CJEM

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“…These changes in physiologic measurements are not specific pain indicators and may also be associated with physical exertion, fever, and anxiety (73). Similarly, although increased changes in physiological parameters have been shown in children in pain, no correlation in children between improved pain scores and changes in respiratory rates, heart rates, or blood pressure has been demonstrated (74).…”

Section: University Of Melbourne Pain Scalementioning

confidence: 99%

The Challenges of Assessing Osteoarthritis and Postoperative Pain in Dogs

Sharkey

2013

AAPS J

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Abstract. The challenge of measuring pain in veterinary medicine is compounded by the lack of fully validated, reliable methods to measure and assess pain in nonverbal patients. In human medicine, there are numerous, validated pain assessment tools (PATs) for assessing various, specific types of pain. The advances in human medicine pain management and numerous validated pain scales should serve as incentives and templates to facilitate similar advances in the development of validated PATs for use in dogs (and other species). The limited number of canine PATs constrains our ability to adequately and reliably assess pain. Improving the ability to quantify osteoarthritis and postoperative pain in dogs would enhance the development of analgesics for animals, advance the management of animal pain, facilitate the use of animal pain models in preclinical trials for human analgesics, and provide insight into the quantification of pain responses in humans who lack the ability to adequately communicate. This review describes the need for practical, valid, and reliable PATs for use in veterinary patients and discusses some currently available PATs commonly used to evaluate acute and chronic pain in dogs.

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Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines—part 1: assessment

et al. 2020

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Self‐reported Pain Scores in the Emergency Department: Lack of Association with Vital Signs

Abstract: Background: Some practitioners and investigators have presumed relationships between pain scores and heart rate, blood pressure, or respiratory rate. Previous literature has not adequately addressed the association of pain and vital signs.

Cited by 50 publications

References 37 publications

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

The Challenges of Assessing Osteoarthritis and Postoperative Pain in Dogs

Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines—part 1: assessment

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