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See Latest ArticlesHow Reliable is Pain as the Fifth Vital Sign?
Journal of the American Board of Family Medicine, 05/11/09
Lorenz KA et al. - Although many health care organizations require routine pain screening (eg, "5th vital sign") with the 0 to 10 numeric rating scale (NRS), its accuracy has been questioned; here the authors evaluated its accuracy and potential causes for error. During 528 encounters, nurse-recorded NRS and research-recorded NRS correlated moderately, as did nurse-recorded NRS and BPI severity scales. Correlation with BPI interference was lower. However, the research-recorded NRS correlated substantially with the BPI severity during the past 24 hours and BPI severity during the last week. Receiver operating characteristic analysis showed similar results. Of the 98% of cases where a numeric score was recorded, 51% of patients reported their pain was rated qualitatively, rather than with a 0 to 10 scale, a practice associated with pain underestimation. Though moderately accurate, the outpatient "5th vital sign" is less accurate than under ideal circumstances. Personalizing assessment is a common clinical practice but may affect the performance of research tools such as the NRS adopted for routine use.
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