Raoul Daoust

Validation and properties of the verbal numeric scale in children with acute pain

&NA; Although the verbal numeric scale (VNS) is used frequently at patients’ bedsides, it has never been formally validated in children with acute pain. In order to validate this scale, a prospective cohort study was performed in children between 8 and 17 years presenting to a pediatric emergency department (ED) with acute pain. Pain was graded using the VNS, the visual analogue scale (VAS), and the verbal rating scale (VRS). A second assessment was done before discharge. We determined a priori that in order to be valid, the VNS would need to: correlate with the VAS (concurrent validity); decrease after intervention to reduce pain (construct validity); and be associated with the VRS categories (content validity). The VNS interchangeability with the VAS, its minimal clinically significant difference, and test–retest reliability were also determined. A total of 202 patients (mean age: 12.2 ± 2.6 years) were enrolled. The VNS correlated with the VAS: ric = 0.93, p < 0.001. There were differences in the VNS before versus after interventions (p < 0.001), and between VRS categories (mild versus moderate, p < 0.001; moderate versus severe, p < 0.001). The 95% limits of agreement (interchangeability) between VNS/VAS were outside the a priori set limit of ±2.0: −1.8, 2.5. The VNS minimal clinically significant difference was 1. The VNS had good test–retest reliability with 95% limits of agreement of −0.9 and 1.2. In conclusion, the VNS provides a valid and reliable scale to evaluate acute pain in children aged 8–17 years but is not interchangeable with the VAS.

Cumulative Incidence of Functional Decline After Minor Injuries in Previously Independent Older Canadian Individuals in the Emergency Department

To estimate the cumulative incidence of functional decline in independent older adults 3 and 6 months after a minor injury treated in the emergency department (ED) and to identify predictors of this functional decline.

Reliability of the visual analog scale in children with acute pain in the emergency department.

Summary The repeatability coefficient of the 100‐mm visual analogue scale in children, a measure of test‐retest reliability, is 12 mm when pain did not change. Abstract In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10 mm on a 100‐mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8–17 years presenting to a pediatric emergency department with acute pain. Pain was graded 4 times using a paper VAS (0–100 mm): T0, T3, T6, and T⩾36 minutes. After T6, patients were asked if their pain had changed since T0 minute. The primary analysis was the repeatability coefficient of the VAS, determined according to the Bland‐Altman method for measuring agreement using repeated measures in patients reporting that their pain was the same for T0, T3, and T6. In order to appropriately estimate the within‐subject SD, 96 patients were required if we obtained 3 measurements for each patient. A total of 151 patients with a mean age of 12.2 ± 2.5 years were enrolled. Among them, 100 mentioned that their pain was the same for T0, T3, and T6 minutes. The repeatability coefficient of the VAS for these children was 12 mm when the pain did not change. This implies that, for a child, all pain intensity measurements within 12 mm should be considered the same pain intensity on a paper VAS. This measure should also be evaluated on other types of VAS.

Basic concepts in the use of thoracic and lung ultrasound.

Purpose of review Recent advances were made in the field of point-of-care ultrasound (POCUS). Thoracic and lung ultrasound have become a rapid and accurate method of diagnosis of hypoxic diseases. The purpose of this article is to review the recent literature on POCUS, emphasizing on its use in the operating room. Recent findings Many international critical care societies published guidelines on the use of ultrasound in the installation of central venous access. More recently, evidenced-based guidelines on the use of POC lung ultrasound were published. Lung ultrasound has shown its superiority over conventional chest radiography in the diagnosis of many disorders of significant importance in anesthesiology, particularly the pneumothorax. Summary POC thoracic and lung ultrasound is used in many critical medicine fields. The aim of this review is to describe the basic lung ultrasound technique and the knowledge required in order to diagnose and treat the hypoxic patient. Emphasis is on disorder such as pleural effusion, alveolar interstitial disease, as well as pneumothorax, which is of particular importance in the field of anesthesiology.

Estimation of pain intensity in emergency medicine: a validation study.

&NA; This study was designed to estimate the validity of an 11‐point verbal numerical rating scale (VNRS) and a 100 Unit (U) plasticized visual analogue scale (VASp) using a 100 mm paper visual analogue scale (VAS) as a gold standard, to recommend the best method of reporting the intensity of acute pain in an emergency department (ED). A convenience sample of 1176 patients with acute pain were recruited in the ED of a teaching hospital. Patients >18 years and able to use the different scales were included. Scales were presented randomly. Results were converted to a 0–100 U scale and validity was quantified using the Bland–Altman method and the intra‐class correlation (ICC). The limits of acceptability were previously set for the limits of agreement at ±20 U, with a constant bias. The Bland–Altman method revealed a small bias of –4 U for the VNRS and +1 U for VASp. However, the bias of the VNRS varied with the intensity of pain from −10 to +1 U. The limits of agreement between the VNRS&VAS and the VASp&VAS were −25; +17 U and −17; +18 U, respectively. The ICC was excellent between the VNRS&VAS (0.88) and the VASp&VAS (0.92). In conclusion, the VASp has a small bias, acceptable limits of agreement and an excellent intra‐class correlation. It is probably a valid tool to estimate acute pain in the ED. However, the VNRS is less valid in that context because of its wide limits of agreement and variable bias (mainly in lower scores).

Current views on acute to chronic pain transition in post-traumatic patients: risk factors and potential for pre-emptive treatments.

E year in the United States, 2.6 million hospital admissions and 36 million emergency department visits are accounted for by trauma patients. Proportionally similar ratios are reported in Canada. In many cases, acute pain from tissue damage subsides normally with wound healing. Yet, in many patients, maladaptive sensitization of the nervous system may trigger chronic pain syndromes that eventually persist for years after that healing has taken place. While the definition of chronic pain may vary, it is generally considered as an ongoing pain state experienced on most days and persisting for at least 3 months. Patients presenting with chronic pain experience persistent manifestations of allodynia, hyperalgesia, and spontaneous pain, making it a major cause of disability. Allodynia is characterized by a painful sensation triggered by normally nonpainful stimuli such as light brushes of the skin or the simple touch of clothes. Hyperalgesia is an exaggerated pain intensity perception for a painful stimuli. ‘‘Spontaneous’’ pain would occur in the absence of identified stimuli and is often considered a major clinical issue in the manifestation of a neuropathic pain state. Underlying inflammation or the physiologic consequences of the summation of allodynic and hyperalgesic stimuli during the course of time may contribute to the physiologic background of apparent ‘‘spontaneous’’ experiences. In Canada, the costs associated with chronic pain total more than those of cancer, heart disease, and human immunodeficiency virus combined, with direct health care costs reaching more than

Measuring Frailty Can Help Emergency Departments Identify Independent Seniors at Risk of Functional Decline After Minor Injuries

6 billion per year. Overall, 60% of active people living with chronic pain will eventually lose their job, incur an income loss, or see their professional responsibilities decrease, depending on the level of disability incurred. The total cost to society amounts to

Is Cognitive Function a Concern in Independent Elderly Adults Discharged Home from the Emergency Department in Canada After a Minor Injury

37 billion per year when global productivity loss and sick leaves are included. This figure compares well with a recent evaluation in the United States where the global financial cost was estimated to be

Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis.

560 to

Impact of Age, Sex and Route of Administration on Adverse Events after Opioid Treatment in the Emergency Department: A Retrospective Study

635 billion annually. We sought to explore the acute to chronic pain transition in posttraumatic patients and the potential of preemptive treatments in at-risk patients. To identify the prevalence, risk factors, and preemptive treatments of chronic pain in the trauma population, we queried the MEDLINE and EMBASE databases with Ovid. Boolean operators were used to create combinations of the following keywords: chronic pain, posttraumatic pain, risk factors, post-surgical pain, post-operative pain, spinal cord injury, traumatic brain injury, orthopedicor limb trauma, burns, burn trauma, thoracic trauma, torso/chest trauma. We limited our search to humans and English or French languages. Relevant articles were identified by the authors from the abstract and the bibliography; disagreements were resolved by discussion. Studies on chronic pain in posttraumatic patients are relatively scarce, although chronic pain develops with significantly high prevalence in various types of posttraumatic patients (Table 1). Globally, chronic pain occurrence across all categories of trauma patients lies between 11% and 96%, depending on the nature of the traumas (as detailed below). A specialized workgroup from the International Association for the Study of Pain has subdivided the general diagnostic of ‘‘chronic pain’’ into more specific taxonomic groups in an effort to refine the current model of the clinical manifestations of chronic pain. Some of these detailed diagnostics refer to generalized pain syndromes, and others refer to specific locations in the neck, head, limbs, thorax, or internal organs and indicate their eventual link to musculoskeletal, neurologic or psychological components (e.g., spinal and radicular pain syndromes, stump pain, complex regional pain syndromes). Up to now, although chronic pain prevalence were reported for several trauma categories, only a few studies were designed to identify which were the factors that could be associated with a transition from acute to chronic pain. Psychosocial and medical aspects, such as lasting anxiety or depressive states, sleep disorders, acute pain intensity, sex, or age, are among the commonly proposed predisposing factors (discussed below). However, recent analyses generally conclude that methodological improvements in the design of clinical studies are first needed before robust risk profiles can be drawn for trauma patients. The prevention of the closely related postsurgical chronic pain, which occurs after iatrogenic tissue injury, is documented more substantially and may constitute a practical source of information for trauma specialists. REVIEW ARTICLE