PT  - JOURNAL ARTICLE
AU  - Lorenz, Karl A.
AU  - Sherbourne, Cathy D.
AU  - Shugarman, Lisa R.
AU  - Rubenstein, Lisa V.
AU  - Wen, Li
AU  - Cohen, Angela
AU  - Goebel, Joy R.
AU  - Hagenmeier, Emily
AU  - Simon, Barbara
AU  - Lanto, Andy
AU  - Asch, Steven M.
TI  - How Reliable is Pain as the Fifth Vital Sign?
AID  - 10.3122/jabfm.2009.03.080162
DP  - 2009 May 01
TA  - The Journal of the American Board of Family Medicine
PG  - 291--298
VI  - 22
IP  - 3
4099  - http://www.jabfm.org/content/22/3/291.short
4100  - http://www.jabfm.org/content/22/3/291.full
SO  - J Am Board Fam Med2009 May 01; 22
AB  - Background: Although many health care organizations require routine pain screening (eg, “5th vital sign”) with the 0 to 10 numeric rating scale (NRS), its accuracy has been questioned; here we evaluated its accuracy and potential causes for error.Methods: We randomly surveyed veterans and reviewed their charts after outpatient encounters at 2 hospitals and 6 affiliated community sites. Using correlation and receiver operating characteristic analysis, we compared the routinely measured “5th vital sign” (nurse-recorded NRS) with a research-administered NRS (research-recorded NRS) and the Brief Pain Inventory (BPI).Results: During 528 encounters, nurse-recorded NRS and research-recorded NRS correlated moderately (r = 0.627), as did nurse-recorded NRS and BPI severity scales (r = 0.613 for pain during the last 24 hours and r = 0.588 for pain during the past week). Correlation with BPI interference was lower (r = 0.409). However, the research-recorded NRS correlated substantially with the BPI severity during the past 24 hours (r = 0.870) and BPI severity during the last week (r = 0.840). Receiver operating characteristic analysis showed similar results. Of the 98% of cases where a numeric score was recorded, 51% of patients reported their pain was rated qualitatively, rather than with a 0 to 10 scale, a practice associated with pain underestimation (χ2 = 64.04, P < .001).Conclusion: Though moderately accurate, the outpatient “5th vital sign” is less accurate than under ideal circumstances. Personalizing assessment is a common clinical practice but may affect the performance of research tools such as the NRS adopted for routine use.