Magazine article Clinical Psychiatry News

Analog Scale Measures Stress in ED Trauma Patients

Magazine article Clinical Psychiatry News

Analog Scale Measures Stress in ED Trauma Patients

Article excerpt

CHICAGO -- Israeli investigators have developed a visual analog scale to measure the intensity of acute stress reaction symptoms in the emergency department.

The scale is similar in design to the widely used Wong-Baker Faces Pain Rating Scale, and accurately predicted the level of emotional reactions weeks after a traumatic event in two studies.

The new scale is the first to measure acute stress reaction symptoms occurring right after a traumatic event, Dr. Ilan Kutz explained at the annual meeting of the International Society for Traumatic Stress Studies. Instruments are available to measure acute stress disorder, but the disorder is typically diagnosed after the first 4 weeks. It's likely that no scale has been developed to measure acute stress reaction symptoms because "it's considered a normative response and so fleeting that people never bothered to attach much attention to it," he said.

Dr. Kutz and his associates developed more than a dozen questionnaires in an attempt to tackle such assessment issues as how to weight various symptoms (for example, hyperarousal vs. disassociation), how to categorize symptom intensity, and who should conduct the assessment and when. In the end, none of the measures were brief or simple to interpret.

"So we designed, out of a bit of despair, another kind of scale taken from the pain visual analog scale that says distress is something the patient and the clinician can point to," said Dr. Kutz, Meir Hospital, Tel-Aviv, Israel.

The 10-point acute stress reaction visual analog scale (ASR-VAS) includes five faces, ranging from a frowning and tearful face representing "extreme distress" to a smiling face for "no distress." The scale was tested by more than 1,000 Israeli clinicians with no training in acute stress reaction and found to be a simple and intuitive measurement for what the patient was experiencing, with a high interrater reliability, he said.

Dr. Kutz and Rachel Dekel, Ph.D., of Bar Ilan University in Ramat-Gan, Israel, then asked 23 victims of a terrorist attack and their clinicians to use the ASR-VAS to rate the intensity of distress within 30 minutes of arrival in the ED and 3-6 hours later after a clinical intervention.

As expected, patients rated their level of distress somewhat higher on arrival than did clinicians (7.4 points vs. 6 points), and the rating given by both groups had significantly decreased upon the patients' release (6. …

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