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Measurement of Pain in the Prehospital Setting Using a Visual Analogue Scale

Published online by Cambridge University Press:  28 June 2012

Bill A. Lord  and
Brian Parsell
Bill A. Lord*
Affiliation:
Senior Lecturer, Monash University Centre for Ambulance and Paramedic Studies, Frankston VIC, Australia
Brian Parsell
Affiliation:
Acting Assistant Operations Manager- Southwestern Sydney Area Ambulance Service of New South Wales, Sydney, Australia
*
Monash University Centre for Ambulance and Paramedic Studies, PO Box 527, Frankston VIC 3199 Australia, E-mail: Bill.lord@med.monash.edu.au
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Abstract

Introduction:

The aim of this study was to use a visual analogue scale (VAS) to measure the adequacy of prehospital pain management. Patients reported pain severity at two points in time during treatment and transport by ambulance paramedics. The change in pain score was compared with a benchmark reduction of 20 mm that has been shown to correspond with the minimum clinically significant change in pain perception reported by patients.

Methods:

This prospective, observational study used a VA S to record pain severity among patients reporting pain who were transported to a hospital by paramedics. Patients used a VAS to score pain severity during the initial patient assessment process (T0), and again at the hospital of destination (Tend). This study reports the mean changes in the scores, and the percentage of cases for whom the difference between T0and Tend in the study population achieved or exceeded the 20 mm benchmark. A survey also was administered to paramedics who participated in this study in order to identify attitudes, values, and beliefs relating to the measurement of pain.

Results:

A total of 262 patients were enrolled in this study. The mean value for thereduction in VAS (T0-Tend) was 18.2±23.9 mm [±SD] (Median = 14.0mm, 95% confidence interval (CI) = 15.3–21.1 mm). One hundred and thirty-four patients (51.1%) did not receive analgesia (either morphine sulfate or methoxyflurane). The mean initial (T0) pain score for the no-analgesia group was 54.5 ±24.7 mm [±SD], with the mean value for the change in VAS (T0-Tend) = 10.6 mm (median = 5 mm, 95% CI = 6.4–14.8 mm). Fo rty-six patients (17.6%) recorded some deterioration in their pain score at Tend (T0-Tend<0 mm). Survey results identified attitudes that may affect paramedics' pain management practice.

Conclusion:

The results suggest that inadequate analgesia is an issue in this study setting. Effective analgesia requires formal protocols or guidelines supported by effective analgesic therapies along with education that addresses attitudes that may inhibit pain assessment or management by paramedics. Regular audits form part of clinical quality assurance programs that assess analgesic practice. However, such auditsmust have access to data obtained from patient self-reporting of pain using a valid and reliable pain measurement tool.

Keywords

benchmarkingemergency medical servicesemergency medical technicianspain measurementprehospitalvisual analogue scale
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 4 , December 2003 , pp. 353 - 358
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

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A correction has been issued for this article:

Erratum