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Identifying the minimum clinically significant difference in acute pain in the elderly.

Polly E Bijur1, Andrew K Chang, David Esses

  • 1Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. Polly.bijur@einstein.yu.edu

Annals of Emergency Medicine
|March 23, 2010
PubMed
Summary

The minimum clinically significant difference in pain for elderly emergency department patients was 1.5 on the numeric rating scale (NRS). This arithmetic difference decreased over time, while the proportional difference remained stable at 25%.

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Area of Science:

  • Geriatric Emergency Medicine
  • Pain Management
  • Clinical Significance

Background:

  • Assessing pain in elderly emergency department (ED) patients is crucial for effective management.
  • Defining a minimum clinically significant difference (MCSD) helps interpret pain scores in this population.
  • Previous research has not clearly established the MCSD for pain in older adults within the ED setting.

Purpose of the Study:

  • To determine the minimum clinically significant difference (MCSD) in pain experienced by elderly patients in the emergency department.
  • To analyze both arithmetic and proportional changes in pain scores over time using the numeric rating scale (NRS).

Main Methods:

  • An observational, prospective study enrolled patients aged 65 years and older with acute pain.

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  • Pain was assessed using an 11-point numeric rating scale (NRS) at baseline and every 30 minutes for 2 hours.
  • Arithmetic MCSD was defined as the mean difference for "a little less/more pain"; proportional MCSD was the change in NRS divided by the initial NRS score.

    • Main Results:

    • The study included 195 elderly patients (mean age 74 years; 73% women).
    • The average arithmetic MCSD was 1.5 NRS units (95% CI 1.3-1.6), decreasing over the 2-hour observation period.
    • The average proportional MCSD was 25% (95% CI 20%-29%), showing stability over time.

    Conclusions:

    • The arithmetic minimum clinically significant difference in pain for older ED patients is 1.5 NRS units.
    • This arithmetic difference diminishes over time, suggesting a potential shift in perception or reporting.
    • The proportional difference of 25% offers a more stable measure of clinically significant pain change in this demographic.