Use of the Visual Analog Scale to Rate and Monitor Severity of Nausea in the Emergency Department

Meek, Robert; Kelly, Anne‐Maree; Hu, Xue

doi:10.1111/j.1553-2712.2009.00581.x

Cited by 54 publications

(74 citation statements)

References 26 publications

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“…Many pharmacologic therapies that are prescribed in the context of pregnancy are not specifically approved for use in a gravid population. 11,20 Although another study using the same database reported an association between filling a prescription for ondansetron and heart defects in the offspring, these data have only been presented in abstract form and cannot be used to establish causation. Nonpregnant patients have shown dramatic responses to this antiemetic, with up to 50% reduction in vomiting when compared with conventional treatments, which has led to prescribing ondansetron during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ondansetron Compared With Doxylamine and Pyridoxine for Treatment of Nausea in Pregnancy

Oliveira

Shannon

You

et al. 2014

Obstetrics &Amp; Gynecology

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Section: Discussionmentioning

confidence: 99%

“…[11][12][13] There are no well-validated tools to measure nausea or vomiting associated with pregnancy. A VAS was used because it correlates well with numerical and verbal descriptors of nausea and has been used in the oncology, emergency medicine, and anesthesia literature to investigate the efficacy of anti-emetic medications.…”

Section: Methodsmentioning

confidence: 99%

Ondansetron Compared With Doxylamine and Pyridoxine for Treatment of Nausea in Pregnancy

Oliveira

Shannon

You

et al. 2014

Obstetrics &Amp; Gynecology

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show abstract

“…35 This sample size would have Ͼ90% power at the 0.01 level of significance to detect a clinically important difference of 2.2 cm in VAS-N for the other 2 hypotheses. 36 We assumed the SD of treated nausea on the VAS-N scale in children is similar to that in adults (2.35 cm) 15,17,36 and that a 1-face difference in the pictorial scale would be considered clinically significant. 37 Spearman's correlation coefficients were calculated between the first paired scores on the VAS and pictorial scales to avoid using scores from the same patient twice.…”

Section: Sample Sizementioning

confidence: 99%

Development and Validation of a Pictorial Nausea Rating Scale for Children

Baxter¹,

Watcha

Baxter³

et al. 2011

Pediatrics

127

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OBJECTIVE: The lack of a widely used, validated measure limits pediatric nausea management. The goal of this study was to create and validate a pictorial scale with regular incremental levels between scores depicting increasing nausea intensity. METHODS: A pictorial nausea scale of 0 to 10 with 6 faces (the Baxter Retching Faces [BARF] scale) was developed in 3 stages. The BARF scale was validated in emergency department patients with vomiting and in healthy patients undergoing day surgery procedures. Patients were presented with visual analog scales for nausea and pain, the pictorial Faces Pain Scale–Revised, and the BARF scale. Patients receiving opioid analgesics or antiemetic agents had their pain and nausea assessed before and 30 minutes after therapy. Spearman's ρ correlation coefficients were calculated. A Wilcoxon matched-pair rank test compared pain and nausea scores before and after antiemetic therapy. RESULTS: Thirty oncology patients and 15 nurses participated in the development of the scale, and 127 patients (52, emergency department; 75, day surgery) ages 7 to 18 years participated in the validation. The Spearman ρ correlation coefficient of the first paired BARF and visual analog scale for nausea scores was 0.93. Visual analog scales for nausea and BARF scores (P = .20) were significantly higher in patients requiring antiemetic agents and decreased significantly after treatment, while posttreatment pain scores (P = .47) for patients receiving only antiemetic agents did not. CONCLUSIONS: We describe the development of a pictorial scale with beginning evidence of construct validity for a self-report assessment of the severity of pediatric nausea. The scale had convergent and discriminant validity, along with an ability to detect change after treatment.

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“…This scale has been validated as a reliable tool for a semi-quantitative assessment of acute pain and nausea in a wide variety of ED patients. 18-24 …”

Section: Methodsmentioning

confidence: 99%

The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness

et al. 2014

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Objectives The hepatic cytochrome 2D6 (CYP2D6) is a saturable enzyme responsible for metabolism of approximately 25% of known pharmaceuticals. CYP interactions can alter the efficacy of prescribed medications. Hydrocodone is largely dependent on CYP2D6 metabolism for analgesia, ondansetron is inactivated by CYP2D6, and oxycodone analgesia is largely independent of CYP2D6. The objective was to determine if CYP2D6 medication co-ingestion decreases the effectiveness of hydrocodone. Methods This was a prospective observational study conducted in an academic U.S. emergency department (ED). Subjects were included if they had self-reported pain or nausea; and were excluded if they were unable to speak English, were less than 18 years of age, had liver or renal failure, or carried diagnoses of chronic pain or cyclic vomiting. Detailed drug ingestion histories for the preceding 48 hours prior to the ED visit were obtained. The patient's pain and nausea were quantified using a 100-millimeter visual analogue scale (VAS) at baseline prior to drug administration and following doses of hydrocodone, oxycodone, or ondansetron. We used a mixed model with random subject effect to determine the interaction between CYP2D6 drug ingestion and study drug effectiveness. Odds ratios (OR) were calculated to compare clinically significant VAS changes between CYP2D6 users and non-users. Results Two hundred fifty (49.8%) of the 502 subjects enrolled had taken at least one CYP2D6 substrate, inhibitor, or inducing pharmaceutical, supplement, or illicit drug in the 48 hours prior to ED presentation. CYP2D6-drug users were one third as likely to respond to hydrocodone (OR 0.33, 95% CI = 0.1 to 0.8), and more than three times as likely as non-users to respond to ondansetron (OR 3.4, 95% CI = 1.3 to 9.1). There was no significant difference in oxycodone effectiveness between CYP2D6 users and non-users (OR 0.53, 95% CI = 0.3 to 1.1). Conclusions CYP2D6 drug-drug interactions appear to change effectiveness of commonly prescribed drugs in the ED. Drug-drug interaction should be considered prior to prescribing CYP2D6 drugs.

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Use of the Visual Analog Scale to Rate and Monitor Severity of Nausea in the Emergency Department

Cited by 54 publications

References 26 publications

Ondansetron Compared With Doxylamine and Pyridoxine for Treatment of Nausea in Pregnancy

Ondansetron Compared With Doxylamine and Pyridoxine for Treatment of Nausea in Pregnancy

Development and Validation of a Pictorial Nausea Rating Scale for Children

The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness

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