Comparison of Visual Analog Pain Score Reported to Physician vs. Nurse, Part II. Issue 3 (14th September 2018)

• Record Type: Journal Article
• Authors: Martin, Kevin; McBride, Trevor; Wake, Jeffrey; Van Buren, Jeffrey; Dewar, Cuyler
• Is Part Of: Foot & ankle orthopaedics. Volume 3:Issue 3(2018)
• Publication Date: 2018-09-14
• Subjects: pain -- visual analog scale -- patient-reported outcome measures -- foot and ankle; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Orthopedics -- Periodicals; 617.584
• DOI: 10.1177/2473011418S00337
• Languages: English
• ISSNs: 2473-0114

Abstract

Category: Ankle Introduction/Purpose: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as researchers and health care networks seek to define treatment outcomes. However, interpretation and clinical applications of PROMs are still under investigation. The visual analogue scale (VAS) is considered a reliable and validated measure of acute pain. In a previous study, it was found that in surgical candidates the VAS pain score was significantly higher when reporting to the surgeon as opposed to the nurse. The aim of this current study is to examine whether this phenomenon occurs in patients that do not ultimately go on to have a surgical procedure. We hypothesize that there will be no difference in patient reporting to the surgeon versus the nursing staff. Methods: This study is a retrospective cohort of 201 consecutive non-surgical foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from "no pain" to worst pain." Differences in reported pain levels were analyzed. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the Surgeon was 4.2 (p<.001). Contrary to our hypothesis, there was a statistically significant difference in pain scores reported to the surgeon compared to the nurse. We then analyzed the mean difference of pain scores reported to surgeon and nurse for surgical versus non-surgical patients. The mean difference in VAS scores reported to physician and nurse for surgical patients was 2.87 whereas the mean difference for non-surgical patients was 1.00 (p < .001). Conclusion: The current study found statistically significant differences between VAS pain scores reported to the surgeon versus the nurse in non-surgical patients. These results support the trend found in our previous study which demonstrated discrepancies in patient pain reporting, with surgical patients reporting significantly higher pain scores to the surgeon versus the nurse. However, the mean difference between reported pain scores, to the providers, is significantly higher for surgical patients as compared to non-surgical patients. The cause of this phenomenon remains unclear, however, this study provides more information regarding patient reported VAS pain scores in an outpatient clinical setting.