Ambulance Research Institute, Ambulance Service of New South Wales, Rozelle, Australia.
Eur J Emerg Med. 2011 Dec;18(6):334-9. doi: 10.1097/MEJ.0b013e328344fdf2.
To determine whether vital signs in patients suffering from acute pain in the out-of-hospital setting have any association with pain severity measured using an ordinal pain scale.
We conducted a retrospective analysis of over 53 000 adult patients aged between 16 and 100 years, who presented to paramedics complaining of acute pain between 1 January 2004 and 30 November 2006. Simple correlation (Spearman's) and ordinal logistic regression techniques were used to create a proportional odds model to explore the relationship between patient-reported pain score and initial vital signs including respiratory rate, pulse rate and blood pressure.
There was a weak but significant correlation between respiratory rate and initial pain score (R=0.15, P<0.0001). In patients aged 16 years and above, those with an initial respiratory rate of 25 breaths/min or more had significantly increased odds (45-105%) of having more severe pain than patients with a respiratory rate of less than 25 breaths/min (P<0.0001). In younger patients (aged between 16 and 64 years), a heart rate of 100 beats/min or more was associated with 18% increased odds of more severe pain (P<0.0001). In older patients (aged between 65 and 100 years), systolic blood pressure of 140 mmHg or more was associated with 14% increased odds of more severe pain (P<0.0001).
An association between prehospital vital signs and pain severity has been shown using ordinal logistic regression. In adults, a respiratory rate of 25 breaths/min or more was the most important predictor of having more severe pain. Tachycardia and systolic hypertension may also be important in younger and older patients, respectively. Simple correlation fails to show clinically important associations between prehospital vital signs and pain severity.
确定院外急性疼痛患者的生命体征与使用等级疼痛量表测量的疼痛严重程度之间是否存在关联。
我们对 2004 年 1 月 1 日至 2006 年 11 月 30 日期间，向护理人员报告急性疼痛的 53000 多名 16 至 100 岁的成年患者进行了回顾性分析。采用简单相关（斯皮尔曼）和有序逻辑回归技术，创建比例优势模型，以探讨患者报告的疼痛评分与初始生命体征（包括呼吸频率、脉搏率和血压）之间的关系。
呼吸频率与初始疼痛评分之间存在微弱但显著的相关性（R=0.15，P<0.0001）。在 16 岁及以上的患者中，初始呼吸频率为 25 次/分钟或更高的患者比呼吸频率低于 25 次/分钟的患者发生更严重疼痛的几率显著增加（45%-105%）（P<0.0001）。在年轻患者（16-64 岁）中，心率为 100 次/分钟或更高与疼痛更严重的几率增加 18%相关（P<0.0001）。在老年患者（65-100 岁）中，收缩压为 140mmHg 或更高与疼痛更严重的几率增加 14%相关（P<0.0001）。
使用有序逻辑回归显示了院前生命体征与疼痛严重程度之间的关联。在成年人中，呼吸频率为 25 次/分钟或更高是疼痛更严重的最重要预测因素。心动过速和收缩期高血压在年轻和老年患者中也可能分别是重要的预测因素。简单相关未能显示院前生命体征与疼痛严重程度之间具有临床意义的关联。
