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Pain scores show no monotonic upward or downward trend over time
Paris B Lovett1, Brian C Jerusik1, Stephanie L Bernard2
1Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Background:
Self-reported pain scales are commonly used in emergency departments (EDs). The 11-point (0-10) numerical rating scale is a commonly used scale for adults visiting EDs in the United States. Despite their widespread use, little is known about whether distribution of pain scores has remained consistent over time.
Objectives:
The objective of this study is to determine if there were upwards or downwards (monotonic) trends in pain scores over time at a single hospital.
Methods:
Retrospective chart review for the years 2003-2011. All pain scores for May 1(st) and 2(nd) of those years were collected. Multinomial logistic regression was used to model the probability of a patient rating their pain in each of 11 categories (scores 0 to 10) as a function of the calendar year. Additional analysis was carried out with pain scores grouped into four categories.
Results:
Data were collected from 2934 patient charts. Pain scores were recorded in 2136 charts, and 1637 of these pain scores were above zero (i.e., 1-10). The pain score distribution differed significantly over time (p = 0.001); however, there was no monotonic (single-direction) trend.
Conclusion:
Although there were significant shifts in pain scores over time, there is not a significant monotonic trend. At this hospital, there was no "inflation" or "deflation" in pain scores over time. Shifts in distribution, even when not in a single direction, may be important for researchers examining pain scores in the ED.
