Duke University School of Nursing, Durham, North Carolina.
Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
J Pain. 2024 Dec;25(12):104658. doi: 10.1016/j.jpain.2024.104658. Epub 2024 Aug 21.
We aimed to determine the minimal clinically important difference (MCID) in pain severity and agreement between the visual analog scale (VAS) and the verbal numeric rating scale (NRS) in people with sickle cell disease (SCD) experiencing an acute vaso-occlusive episode in the emergency department. In the COMPARE-VOE trial (NCT03933397), participants were administered the VAS (0-100), NRS (0-100), and descriptor scale (a lot better, a little better, same, a little worse, much worse) every 30 minutes while in the emergency department. We analyzed data from 100 participants (mean age 30.2 years; 61% female). We calculated the mean differences and 95% confidence intervals (CIs) between current and preceding scores when the participant reported a little worse or a little better pain for each scale (255 VAS and 150 NRS observations) to assess the MCID for the VAS and NRS. Pearson correlation and the Bland-Altman method were used to assess the agreement among 411 paired VAS and NRS observations. Our results indicated that the MCID for the VAS was 8.77 mm (95% CI: 7.43 mm, 10.83 mm) and the NRS was 8.29 (95% CI: 6.47, 11.60). The VAS and NRS scales had a correlation of .88 (P < .001). The Bland-Altman method indicated a mean difference of -4.6 ± 1.96 and the 95% limits of agreement ranged from 20 to -29. Despite high correlation, there was considerable variability of agreement between the VAS and NRS scales, indicating that these scales are not interchangeable to assess pain during a vaso-occlusive event. PERSPECTIVE: The MCID in pain severity for individuals with a SCD vaso-occlusive episode using the VAS (8.77 mm) is lower than previously reported, and the MCID for NRS was 8.29. The agreement between the VAS and NRS was determined and the scales cannot be used interchangeably to measure SCD pain intensity.
我们旨在确定在急诊科经历急性血管阻塞性发作的镰状细胞病（SCD）患者中，视觉模拟量表（VAS）和口头数字评分量表（NRS）之间疼痛严重程度和一致性的最小临床重要差异（MCID）。在 COMPARE-VOE 试验（NCT03933397）中，参与者在急诊科每 30 分钟接受一次 VAS（0-100）、NRS（0-100）和描述符量表（好很多，好一点，相同，差一点，差很多）。我们分析了 100 名参与者（平均年龄 30.2 岁；61%为女性）的数据。我们计算了参与者报告疼痛略有恶化或略有改善时当前和前一次评分之间的平均差异和 95%置信区间（CI）（每个量表有 255 个 VAS 和 150 个 NRS 观察值），以评估 VAS 和 NRS 的 MCID。Pearson 相关和 Bland-Altman 方法用于评估 411 对 VAS 和 NRS 观察值之间的一致性。我们的结果表明，VAS 的 MCID 为 8.77mm（95%CI：7.43mm，10.83mm），NRS 的 MCID 为 8.29（95%CI：6.47，11.60）。VAS 和 NRS 量表之间的相关性为.88（P<0.001）。Bland-Altman 方法表明平均差异为-4.6±1.96，95%置信区间为 20 至-29。尽管相关性很高，但 VAS 和 NRS 量表之间的一致性存在相当大的差异，表明这些量表不能互换用于评估血管阻塞性事件期间的疼痛。观点：使用 VAS（8.77mm）评估 SCD 血管阻塞性发作个体的疼痛严重程度的 MCID 低于之前的报告，NRS 的 MCID 为 8.29。确定了 VAS 和 NRS 之间的一致性，并且这些量表不能互换使用来测量 SCD 疼痛强度。
