{"pk":16184,"title":"Pain Assessment in the Emergency Department: A Prospective Videotaped Study","subtitle":null,"abstract":"Introduction:\n Research suggests that pain assessment involves a complex interaction between patients and clinicians. We sought to assess the agreement between pain scores reported by the patients themselves and the clinician’s perception of a patient’s pain in the emergency department (ED). In addition, we attempted to identify patient and physician factors that lead to greater discrepancies in pain assessment.\nMethods: \nWe conducted a prospective observational study in the ED of a tertiary academic medical center. Using a standard protocol, trained research personnel prospectively enrolled adult patients who presented to the ED. The entire triage process was recorded, and triage data were collected. Pain scores were obtained from patients on a numeric rating scale of 0 to 10. Five physician raters provided their perception of pain ratings after reviewing videos. \nResults:\n A total of 279 patients were enrolled. The mean age was 53 years. There were 141 (50.5%) female patients. The median self-reported pain score was 4 (interquartile range 0-6). There was a moderately positive correlation between self-reported pain scores and physician ratings of pain (correlation coefficient, 0.46; P <0.001), with a weighted kappa coefficient of 0.39. Some discrepancies were noted: 102 (37%) patients were rated at a much lower pain score, whereas 52 (19%) patients were given a much higher pain score from physician review. The distributions of chief complaints were different between the two groups. Physician raters tended to provide lower pain scores to younger (P = 0.02) and less ill patients (P = 0.008). Additionally, attending-level physician raters were more likely to provide a higher pain score than resident-level raters (P <0.001).\nConclusion:\n Patients’ self-reported pain scores correlate positively with the pain score provided by physicians, with only a moderate agreement between the two. Under- and over-estimations of pain in ED patients occur in different clinical scenarios. Pain assessment in the ED should consider both patient and physician factors.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency department"},{"word":"triage"},{"word":"pain assessment"},{"word":"agreement"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6599j2tv","frozenauthors":[{"first_name":"Hao-Ping","middle_name":"","last_name":"Hsu","name_suffix":"","institution":"National Taiwan University, College of Medicine, Department of Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Ming-Tai","middle_name":"","last_name":"Cheng","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Tsung-Chien","middle_name":"","last_name":"Lu","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Yun Chang","middle_name":"","last_name":"Chen","name_suffix":"","institution":"National Taiwan University Hospital Yun-Lin Branch, Department of Emergency Medicine, Hsinchu, Taiwan","department":"None"},{"first_name":"Edward Che-Wei","middle_name":"","last_name":"Liao","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Chih-Wei","middle_name":"","last_name":"Sung","name_suffix":"","institution":"National Taiwan University Hospital Hsin-Chu Branch, Department of Emergency Medicine, Hsinchu, Taiwan","department":"None"},{"first_name":"Chiat Qiao","middle_name":"","last_name":"Liew","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Dean-An","middle_name":"","last_name":"Ling","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Chia-Hsin","middle_name":"","last_name":"Ko","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Nai-Wen","middle_name":"","last_name":"Ku","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Li-Chen","middle_name":"","last_name":"Fu","name_suffix":"","institution":"National Taiwan University, Department of Computer Science and Information Engineering, Taipei, Taiwan","department":"None"},{"first_name":"Chien-Hua","middle_name":"","last_name":"Huang","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Chu-Lin","middle_name":"","last_name":"Tsai","name_suffix":"","institution":"Other","department":"None"}],"date_submitted":"2021-12-05T14:50:04+08:00","date_accepted":"2021-12-05T14:50:04+08:00","date_published":"2022-08-29T04:30:59+08:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/16184/galley/8115/download/"}]}