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Contrary to wards that manage usually chronic or acute pain (algology, gerontology, surgery, recovery room, and so forth), a comparison of the five most popular self-report pain tools (vertical and horizontal Visual Analog Scale (VAS-V, VAS-H), 0 to 10 oral Numeric Rating Scale (NRS-O), 0 to 10 visual enlarged NRS (NRS-V), Verbal Descriptor Scale (VDS)) has never been evaluated in an ICU setting.
Consecutive patients admitted to a medical-surgical ICU during 1 year were included when alert (RASS >-2) and able to follow simple commands. Exclusion criteria: previous self-report pain assessment without the presence of an investigator. Pain assessment using the five scales in random order either at baseline (T1) and after (T2) administration of an analgesic, or during a nociceptive procedure, in absence of pain at baseline. Evaluated parameters: psychometric properties of scales (feasibility, validity, responsiveness and preference). Nonparametric tests were used for statistical analysis (Statview 5.0). Data are expressed as median (25th to 75th).
One hundred patients were included 24 (12 to 96) hours after their admission to the ICU: age 58 (48 to 69) years, SAPS II 39 (32 to 48), SOFA 7 (3 to 9), medical admission (49%), intubation before inclusion (76%), at time to inclusion (50%). At T1, 91% of patients were able to use at least one scale and 57% all five scales. The NRS-V had the lowest failure rate (9%) compared with NRS-O (17%), VDS (22%), VAS-H (32%) and VAS-V (34%). Validity was measured in the 56 patients who were able to use the five scales both at T1 and T2. The pain intensity measured with the five scales changed significantly between T1 and T2 (P < 0.01), showing a good discriminative validity. The correlation between the five scales was important (Spearman's coefficients ranged from 0.75 to 0.96, P < 0.001). The responsiveness was very good for each of the five scales, either after an analgesia and a nociceptive procedure (effect size >0.8). Finally, the NRS-V was considered respectively by 45, 37 and 44% of patients as the easiest, most accurate and preferred scale. The preference for the other scales was <12%.
The self-report of pain is feasible in ICU patients as soon as they are sufficiently alert (RASS >-2) and able to follow simple commands. The enlarged 0 to 10 Numeric Rating Scale is the easiest scale to use with the lowest failure rate and it is the preferred scale for the majority of critically ill patients who were able to communicate.