Identifying the minimum clinically significant difference in acute pain in the elderly

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Study objective: To identify the minimum clinically significant difference in pain in elderly emergency department (ED) patients. Methods: This was an observational, prospective study of a convenience sample of patients aged 65 years or older with acute pain. Patients rated their pain on an 11-point numeric rating scale (NRS) on entering the study and every 30 minutes for 2 hours. The arithmetic minimum clinically significant difference was defined as the mean difference between current and preceding NRS scores when the subject described his or her pain as "a little less pain" or "a little more pain." The proportional minimum clinically significant difference was change in NRS in a 30-minute interval divided by the NRS at the beginning of the interval. We used generalized estimating equations to adjust for nonindependence of pain scores and to test trend over time. Results: One hundred ninety-five patients were enrolled (mean age 74 years; 73% women; 51% Hispanic; 33% black). The arithmetic minimum clinically significant difference averaged over all periods was 1.5 (95% confidence interval 1.3 to 1.6), the proportional minimum clinically significant difference was 25% (95% confidence interval 20% to 29%). The arithmetic minimum clinically significant difference unexpectedly decreased over time: 2.1 from baseline to 30 minutes, 1.4 from 30 to 60 minutes, 1.3 from 60 to 90 minutes, and 1.0 from 90 to 120 minutes (P<.001). In contrast, the proportional differences were more stable: 27% from baseline to 30 minutes, 22% from 30 to 60 minutes, 22% from 60 to 90 minutes, and 28% from 90 to 120 minutes (P=.89). Conclusion: The arithmetic minimum clinically significant difference in older ED patients was 1.5 NRS units and decreased over time, whereas the proportional change was 25% and more stable.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
Volume56
Issue number5
DOIs
StatePublished - Nov 2010

Fingerprint

Acute Pain
Pain
Hospital Emergency Service
Confidence Intervals
Hispanic Americans
Observational Studies
Prospective Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{6ea7c161ef7f4b4dab27666a19dae6dd,
title = "Identifying the minimum clinically significant difference in acute pain in the elderly",
abstract = "Study objective: To identify the minimum clinically significant difference in pain in elderly emergency department (ED) patients. Methods: This was an observational, prospective study of a convenience sample of patients aged 65 years or older with acute pain. Patients rated their pain on an 11-point numeric rating scale (NRS) on entering the study and every 30 minutes for 2 hours. The arithmetic minimum clinically significant difference was defined as the mean difference between current and preceding NRS scores when the subject described his or her pain as {"}a little less pain{"} or {"}a little more pain.{"} The proportional minimum clinically significant difference was change in NRS in a 30-minute interval divided by the NRS at the beginning of the interval. We used generalized estimating equations to adjust for nonindependence of pain scores and to test trend over time. Results: One hundred ninety-five patients were enrolled (mean age 74 years; 73{\%} women; 51{\%} Hispanic; 33{\%} black). The arithmetic minimum clinically significant difference averaged over all periods was 1.5 (95{\%} confidence interval 1.3 to 1.6), the proportional minimum clinically significant difference was 25{\%} (95{\%} confidence interval 20{\%} to 29{\%}). The arithmetic minimum clinically significant difference unexpectedly decreased over time: 2.1 from baseline to 30 minutes, 1.4 from 30 to 60 minutes, 1.3 from 60 to 90 minutes, and 1.0 from 90 to 120 minutes (P<.001). In contrast, the proportional differences were more stable: 27{\%} from baseline to 30 minutes, 22{\%} from 30 to 60 minutes, 22{\%} from 60 to 90 minutes, and 28{\%} from 90 to 120 minutes (P=.89). Conclusion: The arithmetic minimum clinically significant difference in older ED patients was 1.5 NRS units and decreased over time, whereas the proportional change was 25{\%} and more stable.",
author = "Bijur, {Polly E.} and Chang, {Andrew K.} and David Esses and Gallagher, {E. John}",
year = "2010",
month = "11",
doi = "10.1016/j.annemergmed.2010.02.007",
language = "English (US)",
volume = "56",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Identifying the minimum clinically significant difference in acute pain in the elderly

AU - Bijur, Polly E.

AU - Chang, Andrew K.

AU - Esses, David

AU - Gallagher, E. John

PY - 2010/11

Y1 - 2010/11

N2 - Study objective: To identify the minimum clinically significant difference in pain in elderly emergency department (ED) patients. Methods: This was an observational, prospective study of a convenience sample of patients aged 65 years or older with acute pain. Patients rated their pain on an 11-point numeric rating scale (NRS) on entering the study and every 30 minutes for 2 hours. The arithmetic minimum clinically significant difference was defined as the mean difference between current and preceding NRS scores when the subject described his or her pain as "a little less pain" or "a little more pain." The proportional minimum clinically significant difference was change in NRS in a 30-minute interval divided by the NRS at the beginning of the interval. We used generalized estimating equations to adjust for nonindependence of pain scores and to test trend over time. Results: One hundred ninety-five patients were enrolled (mean age 74 years; 73% women; 51% Hispanic; 33% black). The arithmetic minimum clinically significant difference averaged over all periods was 1.5 (95% confidence interval 1.3 to 1.6), the proportional minimum clinically significant difference was 25% (95% confidence interval 20% to 29%). The arithmetic minimum clinically significant difference unexpectedly decreased over time: 2.1 from baseline to 30 minutes, 1.4 from 30 to 60 minutes, 1.3 from 60 to 90 minutes, and 1.0 from 90 to 120 minutes (P<.001). In contrast, the proportional differences were more stable: 27% from baseline to 30 minutes, 22% from 30 to 60 minutes, 22% from 60 to 90 minutes, and 28% from 90 to 120 minutes (P=.89). Conclusion: The arithmetic minimum clinically significant difference in older ED patients was 1.5 NRS units and decreased over time, whereas the proportional change was 25% and more stable.

AB - Study objective: To identify the minimum clinically significant difference in pain in elderly emergency department (ED) patients. Methods: This was an observational, prospective study of a convenience sample of patients aged 65 years or older with acute pain. Patients rated their pain on an 11-point numeric rating scale (NRS) on entering the study and every 30 minutes for 2 hours. The arithmetic minimum clinically significant difference was defined as the mean difference between current and preceding NRS scores when the subject described his or her pain as "a little less pain" or "a little more pain." The proportional minimum clinically significant difference was change in NRS in a 30-minute interval divided by the NRS at the beginning of the interval. We used generalized estimating equations to adjust for nonindependence of pain scores and to test trend over time. Results: One hundred ninety-five patients were enrolled (mean age 74 years; 73% women; 51% Hispanic; 33% black). The arithmetic minimum clinically significant difference averaged over all periods was 1.5 (95% confidence interval 1.3 to 1.6), the proportional minimum clinically significant difference was 25% (95% confidence interval 20% to 29%). The arithmetic minimum clinically significant difference unexpectedly decreased over time: 2.1 from baseline to 30 minutes, 1.4 from 30 to 60 minutes, 1.3 from 60 to 90 minutes, and 1.0 from 90 to 120 minutes (P<.001). In contrast, the proportional differences were more stable: 27% from baseline to 30 minutes, 22% from 30 to 60 minutes, 22% from 60 to 90 minutes, and 28% from 90 to 120 minutes (P=.89). Conclusion: The arithmetic minimum clinically significant difference in older ED patients was 1.5 NRS units and decreased over time, whereas the proportional change was 25% and more stable.

UR - http://www.scopus.com/inward/record.url?scp=78049481224&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049481224&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2010.02.007

DO - 10.1016/j.annemergmed.2010.02.007

M3 - Article

C2 - 20303199

AN - SCOPUS:78049481224

VL - 56

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 5

ER -