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West Indian med. j ; 49(suppl. 2): 61, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-884

RESUMO

OBJECTIVE: To determine whether pain severity scores (visual analogue scale (VAS) from 0-10) and/or grades (none, mild, moderate or severe) for bone pain in children with sickle cell disease, agreed when performed by patients, doctors and nurses, and to determine whether the pain scores and/or grade assigned predicted the use of narcotics or a return visit for the same pain episode. DESIGN AND METHODS: All children aged 5-18 years known to have homozgous SS disease who attended the Sickle Cell Clinic at the University Hospital of the West Indies, and were admitted to the day care center with painful crisis, from 25/04/1999 to 01/06/1999 were invited to participate. Informed consent was obtained. All patients/guardians consented, leading to observation of 30 episodes in 22 children (four children had 2 episodes, two children had 3 episodes). On admission and discharge, pain severity ws confidentially and independently assigned a VAS score and grade by patient, doctor and nurse. Medicatons used for pain were recorded. Patients with return visits within 7 days were noted. Scores/grades by each individual at admission and discharge were compared to the other 2 scores/grades yielding kappa values. The distribution of scores across grades was determined. VAS scores and grades at patient admission and discharge were compared across patient groups defined by subsequent return visit to clinic, using the Mann-Whitney two-sample statistic. RESULTS: Comparison of VAS scores between rates yielded kappas ranging from 0.40 to 0.69, demonstrating fair to substantial agreement, wheras with grades, kappas ranged from 0.52 to 0.90, demonstrating moderate to near perfect agreement. The minimum score associated with norcotic use was 5. The scores/grades at the initial visit did not predict those who would have return visits (po0.4). CONCLUSIONS: The visual analogue scale and grading system can successfully be used in this clinical setting. In this pilot study, doctors and nurses correlated well with patients in scoring the pain. There is a minimum threshold of a score of 5 below which narcotics are not prescribed. Return visits are determined by factors other than the score at initial visit. Further work using this type of tool is to be encouraged.(AU)


Assuntos
Criança , Pré-Escolar , Humanos , Adolescente , Anemia Falciforme/complicações , Medição da Dor/métodos , Jamaica/epidemiologia , Receptores Opioides kappa , Cooperação do Paciente
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