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Updated: Sep 25, 2026

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Acute pain is underassessed in out-of-hospital emergencies
Thomas J Luger1, Wolfgang Lederer, Michael Gassner
1Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Austria.
Objectives:
To evaluate the quality of pain assessment by emergency medical services (EMS) in out-of-hospital emergencies.
Methods:
A prospective study was conducted on a convenience sample of patients during a one-year observation period. Pain ratings assessed by emergency patients were documented at three different intervals during the emergency call, and compared with concomitant assessments by EMS providers. A visual analog scale (VAS) and a verbal pain scale (VPS) were used for pain assessment. Repeated-measures ANOVA and Dunnett's t-test were used for data analysis.
Results:
Fifty-one out of 70 eligible patients met inclusion criteria. In most emergency patients the intensity of pain was underestimated by EMS, especially when pain was severe (p = 0.0001). During the course of transport, both pain and pain assessment by EMS improved significantly (p = 0.0001). The VAS and VPS were significantly correlated (p = 0.0001).
Conclusions:
EMS providers significantly underestimate their patients' pain severity. EMS providers should be more attentive to their patients' complaints and comfort.
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