Does the Numeric Rating Scale (NRS) represent the optimal tool for evaluating pain in the triage process of patients presenting to the ED? Results of a muticenter study.

Pain evaluation at triage in Emergency Department (ED) is fundamental, as it influences significantly patients color code determination. Different scales have been proposed to quantify pain but they are not always reliable. This study aims to determine a) how important is for triage nurses pain measurement b) reliability of Numeric Rating Scale (NRS), the most used instrument to evaluate pain in Italian EDs, because it frequently shows higher pain scores than others scales. METHODS: End point 1: a questionnaire was administered to triage nurses in some hospitals of northern Italy. End point 2: 250 patients arriving at the ED referring pain have been evaluated using, randomly, either the NRS or a fake "30-50" scale. RESULTS: End point 1: Triage nurses acknowledge to modify frequently the referred pain intensity. This for several reasons: nurses think that patients may exaggerate to obtain a higher priority color code; they may be influenced by specific patients categories (non EU citizens, drugs-addicted, elderly); the pain score referred by patients is not correspondent to nurse perception. End point 2: Data show that the mean value obtained with NRS is significantly (p<0.05) higher that the mean obtained with the "30-50" scale. CONCLUSION: Manipulation on pain evaluation performed by nurses might result in a dangerous underestimation of this symptom. At the same time, the use of NRS seems to allow patients to exaggerate pain perception with consequent altered attribution of color code at triage.

Hypertension in diabetic pregnancy: impact and long-term outlook.

Hypertensive disorders in pregnancy can be chronic, pregestational or just diagnosed before the 20th week, or newly diagnosed in the second half of pregnancy. Any type of hypertension is more frequent in diabetic pregnancies with a different distribution among different types of diabetes. Most of the evidence is for pre-eclampsia associated with a marked increase in primary caesarean section, preterm birth and more need for neonatal intensive care. Different risk factors and pregnancy outcomes would support the hypothesis that pre-eclampsia and gestational hypertension might be largely separate entities, but this position is not unanimously accepted. Chronic hypertension increases with age and duration of diabetes, predicting increased rates of prematurity and neonatal morbidity, especially when associated with superimposed pre-eclampsia. Long-term consequences are observed in women whose pregnancy was complicated by hypertension such as chronic hypertension and cardiovascular diseases.

[The plasma fibrinogen as a marker of subclinical carotid atherosclerosis]. / Il fibrinogeno plasmatico come indicatore di aterosclerosi carotidea subclinica.

UNLABELLED: The aim of this study is to evaluate if plasma fibrinogen levels could correlate with carotid lesions. METHODS: We investigated the plasmatic levels of fibrinogen in 100 patients with asymptomatic carotid lesions, examined at ultrasound, and with at least one traditional cardiovascular risk factor. RESULTS: We found a significant correlation between plasma fibrinogen levels and severity of carotid lesions: intima-media thickness (p < 0.001), stenosis <70% (p < 0.002), stenosis 270% (p < 0.001). CONCLUSIONS: Beyond traditional cardiovascular risk factors, high plasmatic levels of fibrinogen significantly correlate with the thickness of carotid wall in asymptomatic subjects.