RESUMO
BACKGROUND: Postoperative nausea and vomiting (PONV) is common but many episodes may be trivial or transient. The aim of the study was to develop a simple-to-use measure of the intensity and clinical impact of PONV. METHODS: We re-analysed data from a study enrolling 163 patients recovering from surgery and anaesthesia that had experienced or were at increased risk of developing PONV. A range of measures of PONV characteristics and quality of recovery were collected. We devised a simplified nausea-vomiting impact scale based on patients' assessment of the impact of their nausea on their postoperative recovery and the number of times they experienced vomiting. We then undertook further tests of construct and discriminant validity, and reliability and responsiveness, of the impact scale using psychometric methodology. RESULTS: Around one in five patients with PONV had features that could classify them as having clinically important PONV. We found that patients with clinically important PONV had a much poorer quality of recovery (P<0.0005), needed more antiemetic administrations for treatment (P<0.0005), and were more likely to have consequences and complications of PONV (all P<0.01), when compared with those with lesser degrees of PONV. A change in clinically important PONV status can be reliably detected with the PONV impact scale. CONCLUSIONS: We have devised and validated a simplified PONV impact scale that can be used to identify those with clinically important PONV. The avoidance of clinically important PONV could be used as a quality indicator or outcome measure after surgery.
Assuntos
Atitude Frente a Saúde , Náusea e Vômito Pós-Operatórios/diagnóstico , Índice de Gravidade de Doença , Adolescente , Adulto , Antieméticos/uso terapêutico , Feminino , Humanos , Masculino , Auditoria Médica/métodos , Pessoa de Meia-Idade , Alta do Paciente , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/psicologia , Psicometria , Indicadores de Qualidade em Assistência à Saúde , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Postoperative nausea and vomiting (PONV) is common and of concern to patients and clinicians. The effect of PONV can range from trivial and transient to major clinical importance, and it is unclear which of its characteristics lead to discomfort and distress. METHODS: We first enrolled 180 participants (patients, family members, nurses, doctors) to identify the characteristics of clinically important PONV, and from these data developed a measurement scale. We then evaluated the scale in a further 163 patients reporting PONV. Validity, reliability, and responsiveness of the PONV Intensity Scale were tested using psychometric techniques. RESULTS: Most participants agreed that three or more vomits, and greater nausea severity and duration, were key factors in defining clinically important PONV. These data were used to derive a PONV Intensity Scale and a score to define clinically important PONV. The scale identified 29 patients (18%) as having clinically important PONV. Patients with clinically important PONV had a poorer quality of recovery (P<0.0005) and needed twice as much antiemetic treatment (P<0.0005). The scale was strongly associated with PONV consequences and complications, with odds ratios ranging from 6.0 to 31 (all P<0.0005). The scale had excellent reproducibility (intraclass correlation 0.99, P<0.0005). The scale could reliably reflect a clinically important change in health status (effect size 0.82, P<0.0005). CONCLUSIONS: The PONV Intensity Scale is a valid, reliable, and responsive measure of clinically important PONV.
