Self Reported Level of Agitation of Patients Presenting to an Emergency Department
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 200
- 试验地点
- 1
- 主要终点
- Brief Agitation Measure
研究概览
简要总结
In recent years, there has been an emphasis on assessing patient's pain on presentation to emergency departments. The Joint Commission mandates that all patients who present with pain must have a pain assessment performed and addressed early in their care. Most emergency departments are using a self-reported assessment of pain using a 1-10 scale of pain. This self-reported level of pain is used to determining appropriate treatment. The Joint Commission has only dealt with somatic pain and has not addressed psychological related pain.
Many authors have written on psychological pain. It is described as introspective experience of negative emotions such as anger, despair, fear, grief, shame, guilt, hopelessness, loneliness and loss. The assessment of psychological pain has been used to describe patients with depression and suicidal thoughts and behaviors.
Study Significance The significance of this study is to determine if patients can communicate the level of psychological pain using the level of agitation as a surrogate marker. Studies have demonstrated that the staff's assessment of a patient's level of agitation is not based on an agitation scale nor uses any patient self-assessment of their level of agitation. If a self-assessment of a patient's level of agitation can be determined early in their care in the emergency setting, a proactive approach to treatment can occur. Proactive agitation treatment has the potential of reducing a patient's agitation and increasing their level of comfort. This early intervention can reduce the progression of agitation and the risk of injury to patients, families and staff.
Hypothesis The study null hypothesis is that the self-rated agitation scale will not have a significant level of correlation with the other measures of agitation (Brief Agitation Measure, Positive And Negative Syndrome Scale and Agitation Calmness Evaluation Scale). The secondary null hypothesis is that there is no difference between the level of agitation and the level of psychological pain, assessed with the Psychological Pain Assessment.
详细描述
In recent years, there has been an emphasis on assessing the patient's pain when the patient presents to emergency departments. The Joint Commission mandates that all patients who present with pain must have a pain assessment performed and addressed early in their care. Most emergency departments are using a self-reported assessment of pain using a 1-10 scale of pain. This self-reported level of pain is used to determine appropriate treatment. The Joint Commission has only dealt with somatic pain and has not addressed psychological pain.
Psychological pain is described as the introspective experience of negative emotions such as anger, despair, fear, grief, shame, guilt, hopelessness, loneliness and loss. The assessment of psychological pain has been used to describe patients with depression and suicidal symptoms.
Some in the field of emergency psychiatry believe patients who are agitated are exhibiting psychological pain, which some argue is no different than somatic pain. However, the principle of somatic pain assessment and treatment has never been applied to the assessment and treatment of psychological pain. Addressing a patient's level of agitation could be used to reduce their agitation and thereby, reduce their psychological pain.
Psychiatric patients frequently present to emergency departments (ED) across the country. Many of these patients are agitated, necessitating treatment for their agitation in the ED. Agitation is thought to be one way a patient expresses psychological pain. If one could assess and treat a patient's agitation, one may be able to reduce psychological pain.
Patients may exhibit various levels of agitation from mild to severe. Patients may progress from one level to the next or stay in one level. Moderate and severely agitated patients are difficult to evaluate and usually need treatment for their agitation. Some of these patients may become violent and injure themselves, staff or others. It is essential to identify patients who might be in the mild to moderate stage in order to prevent progression to severe agitation. This identification can provide a mechanism to determine who needs immediate treatment in the ED.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients can be enrolled in the study only if they meet all of the following criteria:
- •Presenting with a psychiatric complaint.
- •Male or female patients at least 18 years of age.
- •Patients must be emergency department patients during the study.
- •Each patient, or a patient's legal representative (as allowed by local law), must understand the nature of the study and must agree to study enrollment.
- •English speaking.
排除标准
- •Unstable patients
- •Patients who have delirium or dementia will be excluded because of its complicated medical rather than psychiatric etiologies.
- •Pediatric patients
结局指标
主要结局
Brief Agitation Measure
时间窗: 5 MINUTES
The Brief Agitation Measure is a three question tool: (1) I want to crawl out of my skin,(2) I feel so stirred up inside I want to scream and (3) I feel a lot of emotional turmoil in my gut. Each item is scored from 1-7 so the scores are from 3-21. Higher scores are considered great level of agitation.
次要结局
- Positive and Negative Syndrome Scale(3 hours)
研究者
Leslie Zun, MD
Chairman
Mt Sinai Hospital, Chicago