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Schmerzerfassung bei invasiven diagnostischen Prozeduren

Vergleich einer elfstufigen numerischen Rangskala und einer sechsstufigen verbalen Kategorialskala zur Schmerzmessung bei Knochenmarkpunktion

Pain assessment in invasive diagnostic procedures

Comparison of an eleven-point numerical rating scale and a six-point verbal rating scale for pain measurement in bone marrow puncture

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Zusammenfassung

Hintergrund und Fragestellung

Die Schmerzmessung ist auch bei invasiven diagnostischen Prozeduren die selbstverständliche Prämisse für eine adäquate Therapie. Untersucht wird, inwieweit eine 11-stufige numerische Rang- und eine 6-stufige verbale Kategorialskala miteinander korrelieren und wie eine Zuordnung zwischen den Werten der beiden Skalen aussehen könnte.

Methoden

Patienten einer hämatologischen Tagesklinik, bei denen eine Knochenmarkpunktion durchgeführt wurde, wurden gebeten, die von ihnen während der Punktion empfundene Schmerzstärke auf einer numerischen Rang- und einer verbalen Kategorialskala anzugeben.

Ergebnisse

Die Auswertung der Patientenangaben bei 263 Punktionen ergab eine sehr gute Korrelation zwischen numerischer Rang- und verbaler Kategorialskala (Spearman Korrelationskoefizient 0,86). Mit Hilfe einer Transfervorschrift wurden Kategorien der verbalen Skala Ziffern der numerischen Rankskala zugeordnet (0 - kein Schmerz, 1 oder 2 - leichter S., 3, 4 oder 5 - mäßiger S., 6 oder 7 - starker S., 8, 9 oder 10 - sehr starker bis stärkst möglicher Schmerz). Dabei ergab sich eine gute Übereinstimmung mit einem gewichteten k-Maß von 0,72 (95% Konfidenzintervall 0,66–0,79).

Schlussfolgerung

Beide Skalen können effizient zur Schmerzerfassung bei diagnostischen Prozeduren verwendet werden. Aufgrund der guten Korrelation können verbalen Kategorien Zahlenwerte und umgekehrt numerischen Werten verbale Kategorien zugeordnet werden. Infolge der interindividuellen Streuung kann jedoch gerade bei der einmaligen Schmerzerfassung hinsichtlich dieser Zuordnung eine Rückversicherung beim Patienten sinnvoll sein, um eine Über- bzw. Unterbehandlung zu vermeiden.

Abstract

Background and objective

Pain measurement during diagnostic procedures is an accepted prerequisite for appropriate therapy. In this study, the agreement between rankings of pain intensity on a numerical and a verbal rating scale was analyzed.

Methods

Patients attending a haematological outpatient clinic who underwent bone marrow puncture were requested to assess pain intensity perceived during the procedure on a elenpoint numerical and a six-point verbal rating scale.

Results

Analysis of patients’ pain ratings in 263 bone marrow punctures showed a very good correlation between numerical and verbal rating scale (Spearman correlation coefficient 0,86). By means of a transfer instruction categories of the verbal rating scale were assigned to figures of the numerical rating scale (0 - no pain, 1 or 2 - mild p., 3, 4 or 5 moderate p., 6 or 7 severe p., 8, 9 or 10 - very severe and worst possible pain). The resulting transfer table showed a good agreement with a weighted kappa of 0.72 (95% confidence interval: 0.66–0.79).

Conclusion

Both scales can be employed efficiently for pain assessment during diagnostic procedures. Verbal categories can be assigned to numerical values and vice versa numerical values to verbal categories. However, in view of the inter-individual variations it appears appropriate to re-assure pain perception with each patient in order to avoid over- or undertreatment.

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Authors and Affiliations

  1. III. Medizinische Klinik, Universitätskliniken Mainz

    M. Weber, J. Kuball & H. Gamm

  2. Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätskliniken Mainz

    J. Schüz

  3. Klinik für Anästhesiologie, Universitätskliniken Mainz

    J. Jage

  4. III. Medizinische Klinik, Universitätskliniken, 55101 , Mainz

    M. Weber

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  1. M. Weber
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  2. J. Schüz
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  3. J. Kuball
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  4. H. Gamm
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  5. J. Jage
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Correspondence to M. Weber.

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Weber, M., Schüz, J., Kuball, J. et al. Schmerzerfassung bei invasiven diagnostischen Prozeduren. Schmerz 19, 513–520 (2005). https://doi.org/10.1007/s00482-005-0393-z

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