No abstract

Full funding sources listed at the end of the paper (see Acknowledgments).

Objectives: To test the agreement between the visual analogue scale (VAS) and a verbal numeric rating scale (VNRS) in measuring acute pain, and measure the minimum clinically significant change in VNRS. Methods: Patients scored their pain by the VAS and the VNRS, then re‐scored their pain every 30 min for up to 2 h. Patients also recorded whether their pain had improved or worsened. Agreement between scores was evaluated, and where patients scored their pain as ‘a bit worse’ or ‘a bit better’ the mean change in VNRS was calculated. Results: A total of 309 paired observations were obtained from 79 patients. The VAS and VNRS were highly correlated (r = 0.95, 95% CI 0.94–0.96). The VNRS was significantly higher than the VAS for the paired observations, with 95% of the differences between VAS and VNRS lying between −2.3 and 1.3 cm. The minimum clinically significant difference in VNRS was 1.4 cm (95% CI 1.2–1.6). Conclusions: The VNRS performs as well as the VAS in assessing changes in pain. However, although the VAS and VNRS are well correlated, patients systematically score their pain higher on the VNRS, with an unacceptably wide distribution of the differences.

Training and the practice of emergency medicine are stressful endeavours, placing emergency medicine physicians at risk of burnout. Burnout syndrome is associated with negative outcomes for patients, institutions and the physician. The aim of this review is to summarise the available literature on burnout among emergency medicine physicians and provide recommendations for future work in this field. A search of MEDLINE (1946-present) (search terms: 'Burnout, Professional' AND 'Emergency Medicine' AND 'Physicians'; 'Stress, Psychological' AND 'Emergency Medicine' AND 'Physicians') and EMBASE (1988-present) (search terms: 'Burnout' AND 'Emergency Medicine' AND 'Physicians'; 'Mental Stress' AND 'Emergency Medicine' AND 'Physicians') was performed. The authors focused on articles that assessed burnout among emergency medicine physicians. Most studies used the Maslach Burnout Inventory to quantify burnout, allowing for cross-study (and cross-country) comparisons. Emergency medicine has burnout levels in excess of 60% compared with physicians in general (38%). Despite this, most emergency medicine physicians (>60%) are satisfied with their jobs. Both work-related (hours of work, years of practice, professional development activities, non-clinical duties etc.) and non-work-related factors (age, sex, lifestyle factors etc.) are associated with burnout. Despite the heavy burnout rates among emergency medicine physicians, little work has been performed in this field. Factors responsible for burnout among various emergency medicine populations should be determined, and appropriate interventions designed to reduce burnout.