Measuring the minimum clinically significant difference in acute pain: Etiology, direction, and time of assessment - 25/08/11
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Abstract |
Study objectives: We determine the minimum clinically significant difference (MCSD) in visual analog scale (VAS) pain scores for acute thoracoabdominal pain in the emergency department (ED) and identify demographic, clinical, and time factors affecting this value. This was a prospective observational cohort study at a university-based ED. Participants were consecutive adult patients with acute thoracoabdominal pain.
Methods: Patients marked the level of their pain on a 100-mm VAS at baseline and at 20-minute intervals thereafter. Simultaneously, patients were asked to rate their pain as “much less,” “a little less,” “about the same,” “a little more,” or “much more” while also marking the level of pain on a VAS. MCSD was defined as the mean difference between current and preceding VAS scores when a patient reported pain as “a little less pain” or “a little more” compared with the previous rating.
Results: Three hundred six patients were enrolled, and 376 pain contrasts were rated as “a little less” and 52 as “a little more” pain. The MCSD overall in this sample was calculated as 24.2 mm (95% confidence interval 22.6 to 25.7 mm). However, at 20 minutes, the mean MCSD for “a little more” pain (17.1±7.4) was significantly lower than the absolute value of the mean VAS change for “a little less” pain (27.1±17.0; P=.02). The MCSD for “a little less” pain at 60 minutes (Tables 1 and 2) was significantly lower than “a little less” pain at the 20-minute interval (22.1 versus 27.1 mm, respectively; P=.01).
Conclusion: The MCSD for patients with thoracoabdominal pain in this Turkish sample was 24.2 mm. The MCSD varied as a function of etiology and assessment period. “A little less” pain represented greater changes in VAS than “a little more” pain in this population.
Table 1, abstract 28660-Minute VAS scores and mean differences in 60-minute and MCSD values in various diagnostic groups in the ED.Final ED DiagnosesNo. (%)Mean VAS at 60 Min, mm (SD)
Mean Difference in VAS in 60 Min, mm (SD)†MCSD, mm (SD)‡Renal colic59 (19.3)15.0 (22.9)−61.3 (28.4)25.2 (25.8)Gastroenteritis28 (9.2)14.7 (15.6)−43.7 (28.4)19.7 (21.7)Nonspecific abdominal pain11 (37.9)18.6 (26.1)−44.6 (31.1)18.9 (20.9)Acute abdomen31 (10.1)38.2 (26.4)−32.0 (35.2)15.5 (22.4)Low back pain17 (5.6)28.3 (25.3)−41.3 (28.7)15.2 (19.6)Coronary artery disease21 (6.9)19.4 (27.1)−50.2 (28.4)20.2 (21.5)Urinary tract infection11 (3.6)18.8 (16.8)−47.0 (22.7)16.1 (15.4)Pelvic inflammatory disease8 (2.6)17.4 (23.4)−42.0 (40.6)18.1 (17.9)Pyelonephritis5 (1.6)15.6 (11.3)−50.8 (31.9)16.93 (16.0)Musculoskeletal pain10 (3.3)29.1 (25.0)−43.0 (28.3)15.6 (20.3)Total306 (100)20.4 (24.9)−47.1 (30.9)24.2 (16.1)P=.004.†P=.009.‡P=.022
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P=.004.[†] P=.009.
[‡] P=.022
Table 2, abstract 286Studies that focused on the MCSD in acute pain in ED patients.AuthorsYearLocationNo.Eligibility“A Little Less”“A Little More”MCSD, mmEthnicity/LanguageTodd et al1996United States(adult)48T413913White vsblackKelly et al1998Australia(adult)152T and NT58369English-speakingPowell et al2001Australia(children)73T and NT564710English-speakingGallagheret al (9)2001United States(adult)96T and NT934813English versus Spanish-speakingGallagher et al2002United States(adult)101Acute abdomen805116English vs Spanish-speakingDegerliet alTurkey(adult)306TAP3765224,2TurkishT, Trauma; NT, nontrauma; TAP, thoracoabdominal pain.
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| T, Trauma; NT, nontrauma; TAP, thoracoabdominal pain. |
Vol 44 - N° 4S
P. S88 - ottobre 2004 Ritorno al numero
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