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The Assessment and Interpretation of Vital Signs

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Textbook of Rapid Response Systems

Abstract

This review reports recent research into the four classic vital signs and how their normal ranges should be defined. It also considers other parameters that might be used as additional vital signs such as pain, breathlessness, mental and functional capacity, and biomarkers. The importance of changes, fluctuations, and trends in vital signs as well as how they are influenced by age is also discussed.

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References

  1. Campbell JN. American pain society 1995 presidential address. Pain forum. J Pain. 1996;5:85–8.

    Google Scholar 

  2. Registered Nurses’ Association of Ontario. Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD). Toronto, Canada: Registered Nurses’ Association of Ontario; 2005.

    Google Scholar 

  3. Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C. Pulse oximetry as a fifth vital sign in emergency geriatric assessment. Acad Emerg Med. 1998;5:858–65.

    Article  CAS  PubMed  Google Scholar 

  4. Neff T. Routine oximetry. A fifth vital sign? Chest. 1988;94:227.

    Article  CAS  PubMed  Google Scholar 

  5. Flaherty JH, Rudolph J, Shay K, Kamholz B, Bookvar KS, Shaughnessy M, Shapiro R, Stein J, Weir C, Edes T. Delirium is a serious and unrecognized problem: why assessment of mental status should be the sixth vital sign. J Am Med Dir Assoc. 2007;8:273–5.

    Article  PubMed  Google Scholar 

  6. Bierman AS. Functional status: the sixth vital sign. J Gen Intern Med. 2001;16:785–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.

    Article  PubMed  Google Scholar 

  8. Hutchinson J. On the capacity of the lungs, and on the respiratory functions with a view to establishing a precise and easy method of detecting disease by the spirometer. Med Chir Trans. 1846;29:137–252.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mackowiak PA, Wasserman SS, Levine MM. A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature and other legacies of Carl Reinhold August Wunderlich. JAMA. 1992;268:1578–80.

    Article  CAS  PubMed  Google Scholar 

  10. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified early warning score in medical admissions. Q J Med. 2001;94:521–6.

    Article  CAS  Google Scholar 

  11. Duckitt RW, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, Forni LG. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study. Br. J. Anaesth. 2007;98:769–74.

    Google Scholar 

  12. Jones AE, Yiannibas V, Johnson C, Kline JA. Emergency department hypotension predicts sudden unexpected in-hospital mortality. Chest. 2006;130:941–6.

    Article  PubMed  Google Scholar 

  13. Allgower M, Buri C. Shockindex Deutsche Medizinische Wochenschrift 1967; 46:1–10.

    Google Scholar 

  14. Morgan RJ, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intensive Care. 1997;8:100.

    Google Scholar 

  15. Royal College of Physicians; National early warning score (NEWS): standardising the assessment of acute illness severity in the NHS. Report of a working party. London: RCP 2012. <www.rcplondon.ac.uk/resources/nationalearlywarningscore-news>.

  16. Bleyer AJ, Vidya S, Russell GB, et al. Longitudinal analysis of one million vital signs in patients in an academic medical center. Resuscitation. 2011;82:1387–92.

    Article  PubMed  Google Scholar 

  17. Kellett J, Kim A. Validation of an abbreviated Vitalpac TM early warning score (ViEWS) in 75, 419 consecutive admissions to a Canadian Regional Hospital. Resuscitation. 2011;83:297–302.

    Article  PubMed  Google Scholar 

  18. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI, Higgins B. A review, and performance evaluation, of single-parameter “track and trigger” systems. Resuscitation. 2008;79:11–21.

    Article  PubMed  Google Scholar 

  19. Osler W. Neuroses of the heart. In: Osler W, editor. The principles and practice of medicine. Edinburgh and London: Young J. Pentland; 1901. p. 759.

    Google Scholar 

  20. Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart. 5th ed. New York: New York Heart Association; 1953.

    Google Scholar 

  21. Spodick DH, Raju P, Bishop RL, Rifkin RD. Operational definition of normal sinus heart rate. Am J Cardiol. 1992;69:1245–6.

    Article  CAS  PubMed  Google Scholar 

  22. Scott O, Williams GJ, Fiddler GI. Results of 24 hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10 to 13 years. Br Heart J. 1980;44:304–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Brodsky M, Wu D, Denes P, et al. Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol. 1977;39:390–5.

    Article  CAS  PubMed  Google Scholar 

  24. Bjerregaard P. Mean 24 hour heart rate, minimal heart rate, and pauses in healthy subjects 40-79 years of age. Eur Heart J. 1983;4:44–51.

    Article  CAS  PubMed  Google Scholar 

  25. Hilgard J, Ezri MD, Denes P. Significance of ventricular pauses of three seconds or more on 24 hour Holter recordings. Am J Cardiol. 1985;55:1005–8.

    Article  CAS  PubMed  Google Scholar 

  26. Agruss NS, Rosin EY, Adolph RJ, Fowler NO. Significance of chronic sinus bradycardia in elderly people. Circulation. 1972;46:924–30.

    Article  CAS  PubMed  Google Scholar 

  27. Tresch DD, Fleg JL. Unexplained sinus bradycardia: clinical significance and long term prognosis in apparently healthy persons older than 40 years. Am J Cardiol. 1986;58:1009–12.

    Article  CAS  PubMed  Google Scholar 

  28. Churpek MM, Yuen TC, Huber MT, Park SY, Hall JB, Edelson DP. Predicting cardiac arrest on the wards a nested case-control study. Chest. 2012;141:1170–6.

    Article  PubMed  Google Scholar 

  29. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest. 1992;101:1644–55.

    Article  CAS  PubMed  Google Scholar 

  30. O’Brien E, Murphy J, Tyndall A, Atkins N, Mee F, McCarthy G, Staessen J, Cox J, O’Malley K. Twenty-four-hour ambulatory blood pressure in men and women aged 17 to 80 years: the allied Irish bank study. J Hypertens. 1991;9:355–60.

    Article  PubMed  Google Scholar 

  31. Stern SA, Dronen SC, Birrer P, Wang X. Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular injury. Ann Emerg Med. 1993;22:155.

    Article  CAS  PubMed  Google Scholar 

  32. Wonka F. Oscillometric blood pressure measurement: description of the method used. Z Kardiol. 1996;85:1–7.

    PubMed  Google Scholar 

  33. Beaubien ER, Card CM, Card SE, Biem HJ, Wilson TW. Accuracy of the dinamap 1846 XT automated blood pressure monitor. J Hum Hypertens. 2002;16:647–52.

    Article  CAS  PubMed  Google Scholar 

  34. Deakin CD, Low JL. Accuracy of the advanced trauma support guidelines for predicting systolic blood pressure using carotid, femoral and radial pulses: observational study. BMJ. 2000;321:673–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;12:818–29.

    Article  Google Scholar 

  36. Olsson T, Lind L. Comparison of the rapid emergency medicine score and APACHE II in non-surgical emergency department patients. Acad Emerg Med. 2003;10:1040–8.

    Article  PubMed  Google Scholar 

  37. Rhee K, Fisher C, Willitis N. The rapid acute physiology score. Am J Emerg Med. 1987;5:278–86.

    Article  CAS  PubMed  Google Scholar 

  38. Le Gall J-R, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63.

    Article  CAS  PubMed  Google Scholar 

  39. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality probability models (MPM II) based on an international cohort of intensive care patients. JAMA. 1993;270:2478–86.

    Article  CAS  PubMed  Google Scholar 

  40. Ikeda M, Matsunaga T, Irabu N, Yoshida S. Using vital signs to diagnose impaired consciousness: cross sectional observational study. BMJ. 2002;325:800–5.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Guyton AC, Hall JE. Textbook of medical physiology. 9th ed. Philadelphia: W.B. Saunders; 1996. p. 209–20.

    Google Scholar 

  42. Mackowiak PA. Concepts of fever. Arch Intern Med. 1998;158:1870–81.

    Article  CAS  PubMed  Google Scholar 

  43. Sund-Levander M, Forsberg C, Wahren LK. Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review. Scand J Caring Sci. 2002;16:122–8.

    Article  PubMed  Google Scholar 

  44. Tanner JM. Relation of heart rate and body temperature in man at rest. J Physiol. 1951;114:9–10p.

    CAS  PubMed  Google Scholar 

  45. Lyon D. The relation of pulse-rate to temperature in febrile conditions. Q J Med. 1927;20:205–18.

    Article  Google Scholar 

  46. Davies P, Maconochie I. The relationship between body temperature, heart rate and respiratory rate in children. Emerg Med J. 2009;26:641–3.

    Article  CAS  PubMed  Google Scholar 

  47. Jensen MM, Brabrand M. The relationship between body temperature, heart rate and respiratory rate in acute patients at admission to a medical care unit. 6th Danish emergency medicine conference, Odense 2014. Abstracts. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015 23(Suppl 1):A12.

    Google Scholar 

  48. Young PJ, Saxena M. Fever management in intensive care patients with infections. Crit Care. 2014;18:206.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kushimoto S, Yamanouchi S, Endo T, Sato T, Nomura R, Fujita M, Kudo D, Omura T, Miyagawa N, Sato T. Body temperature abnormalities in non-neurological critically ill patients: a review of the literature. J Intensive Care. 2014;2:14.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Henriksen DP, Jensen HCK, Laursen CB, Lassen AT. Increased short-term mortality among normothermic patients presenting to a medical emergency department with infection - a cohort study. 6th Danish Emergency Medicine Conference, Odense 2014. Abstracts. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015 23(Suppl 1): A26.

    Google Scholar 

  51. Henriksen DP, Laursen CB, Lassen AT. Patients hospitalized with severe infections and hypothermia, a cohort study of mortality and prognostic factors. 6th Danish emergency medicine conference, Odense 2014. Abstracts. Scand J Trauma, Resusc Emerg Med. 2015;23(Suppl 1):A27.

    Article  Google Scholar 

  52. Cretikos M, Chen J, Hillman K, Bellomo R, Finfer S, Flabouris A. The MERIT study investigators. The objective medical emergency team activation criteria: a case-control study. Resuscitation. 2007;73:62–72.

    Article  PubMed  Google Scholar 

  53. Cretikos MA, Bellomo R, Hillman K, Chen J, Finfer S, Flabouris A. Respiratory rate: the neglected vital sign. Med J Aust. 2008;188:657–9.

    PubMed  Google Scholar 

  54. Lovett PB, Buchwald JM, Sturmann K, Bijur P. The vexatious vital: neither clinical measurements by nurses nor electronic monitor provides accurate measurements of respiratory rate in triage. Ann Emerg Med. 2005;45:68–76.

    Article  PubMed  Google Scholar 

  55. Tarassenko L, Villarroel M, Guazzi A, Jorge J, Clfton DA, Pugh C. Non-contact video-based vital sign monitoring using ambient light and auto-regressive models. Physiol Meas. 2014;35:807–31.

    Article  CAS  PubMed  Google Scholar 

  56. Kellett J, Li M, Rasool S, Green GC, Seely A. Comparison of the heart and breathing rate of acutely ill medical patients recorded by nursing staff with those measured over 5 min by a piezoelectric belt and ECG monitor at the time of admission to hospital. Resuscitation. 2011;82:1381–6.

    Google Scholar 

  57. Lim WS, Carty SM, Macfarlane JT, et al. Respiratory rate measurement in adults – how reliable is it? Respir Med. 2002;96:31–3.

    Google Scholar 

  58. Lui LL, Gallaher MM, Davis RL, et al. Use of a respiratory clinical score among different providers. Pediatr Pulmonol. 2004;37:243–8.

    Google Scholar 

  59. Brodersen JB, Hallas P, Brabrand M. Respiratory rate – interobserver reliability study. 6th Danish Emergency Medicine Conference, Odense 2014. Abstracts. Scand J Trauma, Resusc Emerg Med. 2015;23(Suppl 1):A14.

    Google Scholar 

  60. Hooker EA, O’Brien DJ, Danzel DF, Barefoot JAC, Brown JE. Respiratory rates in emergency department patients. J Emerg Med. 1989;7:129–32.

    Article  CAS  PubMed  Google Scholar 

  61. Hutchinson J. Thorax. In: Todd RB. editor. Cyclopaedia of anatomy and physiology. London: Longman, Brown, Green, Congmans, and Roberts; 1849:IV. p. 1079–87.

    Google Scholar 

  62. Mead JH. Control of respiratory frequency. J Appl Physiol. 1960;15:325–36.

    Google Scholar 

  63. McFadden JP, Price RC, Eastwood HD, Briggs RS. Raised respiratory rate in elderly patients: a valuable physical sign. BMJ. 1982;284:626–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Kellett J, Deane B. The simple clinical score predicts mortality for 30 days after admission to an acute medical unit. Q J Med. 2006;99:771–81.

    Article  CAS  Google Scholar 

  65. Otis AB, Fenn WG, Rahn H. Mechanics of breathing in man. J Appl Physiol. 1950;2:592–607.

    CAS  PubMed  Google Scholar 

  66. McIlroy MB, Marshall R, Christie RV. The work of breathing in normal subjects. Clin Sci. 1954;13:127–36.

    CAS  PubMed  Google Scholar 

  67. Marshall R, Christie RV. The visco-elastic properties of the lungs in acute pneumonia. Clin Sci. 1954;13:403–8.

    CAS  PubMed  Google Scholar 

  68. Hillman K, Chen J, Cretikos M, et al. MERIT study investigators. Introduction of the medical emergency team (MET) system: a cluster randomised controlled trial. Lancet. 2005;365:2091–7.

    Article  PubMed  Google Scholar 

  69. Subbe CP, Davies RG, Williams E, et al. Effect of introducing the modified early warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia. 2003;58:797–802.

    Article  CAS  PubMed  Google Scholar 

  70. Hodgetts TJ, Kenward G, Vlachonikalis IG, et al. The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation. 2002;54:125–31.

    Article  PubMed  Google Scholar 

  71. Fieselmann JF, Hendryx MS, Helms CM, et al. Respiratory rate predicts cardiopulmonary arrest for internal medicine patients. J Gen Intern Med. 1993;8:354–60.

    Article  CAS  PubMed  Google Scholar 

  72. Goldhill DR, McNarry AF, Mandersloot G, et al. A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia. 2005;60:547–53.

    Article  CAS  PubMed  Google Scholar 

  73. Goldhill DR, McNarry AF. Physiological abnormalities in early warning scores are related to mortality in adult inpatients. Br J Anaesth. 2004;92:882–4.

    Article  CAS  PubMed  Google Scholar 

  74. Harrison GA, Jacques TC, Kilborn G, et al. The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards — the SOCCER study. Resuscitation. 2005;65:149–57.

    Google Scholar 

  75. Rady MY, Nightingale P, Little RA, Edwards JD. Shock index: a re-evaluation in acute respiratory failure. Resuscitation. 1992;23:227–34.

    Article  CAS  PubMed  Google Scholar 

  76. Rady MY. The role of central venous oximetry, lactic acid concentration and shock index in the evaluation of clinical shock: a review. Resuscitation. 1992;24:55–60.

    Article  CAS  PubMed  Google Scholar 

  77. Rady MY, Rivers EP, Martin GB, Smithline H, Appelton T, Nowak RM. Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock. Am J Emerg Med. 1992;10:538–41.

    Article  CAS  PubMed  Google Scholar 

  78. Victor M, Ropper AH. Coma and related disorders of consciousness. In: Adams and Victor’s principles of neurology. 7th ed. New York: McGraw-Hill; 2001. p. 366–89.

    Google Scholar 

  79. Birkhahn RH, Gaeta TJ, Bei R, Bove JJ. Shock index in the first trimester of pregnancy and its relationship to ruptured ectopic pregnancy. Acad Emerg Med. 2002;9:115–9.

    Article  PubMed  Google Scholar 

  80. King RW, Plewa MC, Buderer NM, Knotts FB. Shock index as a marker for significant injury in trauma patients. Acad Emerg Med. 1996;3:1041–5.

    Article  CAS  PubMed  Google Scholar 

  81. Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of the shock index and conventional vital signs to identify acute critical illness in the emergency department. Ann Emerg Med. 1994;24:685–90.

    Article  CAS  PubMed  Google Scholar 

  82. Kline JA, Nelson RD, Jackson RE, Courtney DM. Criteria for the safe use of d-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study. Ann Emerg Med. 2002;39:144–52.

    Article  PubMed  Google Scholar 

  83. Ostern HJ, Trentz O, Hemplemann G, Trentz OA, Sturm J. Cardiorespiratory and metabolic patterns in multiple trauma patients. Resuscitation. 1980;7:169–84.

    Article  Google Scholar 

  84. Fundamental Critical Care Support, 3rd Edition. In: Zimmerman JL. editor. Society of critical care medicine des plaines. Illinois; 2001, p. 9–4.

    Google Scholar 

  85. Yang P-L, Li Y-C. Pulse pressure index (pulse pressure/systolic pressure) may be better than pulse pressure for assessment of cardiovascular outcomes. Med Hypotheses. 2009;72:729–31.

    Article  Google Scholar 

  86. Sinex JE. Pulse oximetry: principles and limitations. Am J Emerg Med. 1999;17:59–67.

    Article  CAS  PubMed  Google Scholar 

  87. Smith GB, Poplett N. Knowledge of aspects of acute care in trainee doctors. Postgrad Med J. 2002;78:335–8.

    Article  PubMed  PubMed Central  Google Scholar 

  88. McGee S, Abernethy WB, Simel DL. Is this patient hypovolemic? JAMA. 1999;281:1022–9.

    Article  CAS  PubMed  Google Scholar 

  89. Pilling J, Cutaia M. Ambulatory oximetry monitoring in patients with severe COPD: a preliminary study. Chest. 1999;116:314–21.

    Article  CAS  PubMed  Google Scholar 

  90. Schenkel NS, Burdet L, de Muralt B, Fitting JW. Oxygen saturation during daily activities in chronic obstructive pulmonary disease. Eur Respir J. 1996;9:2584–9.

    Article  Google Scholar 

  91. Rao V, Todd TRJ, Kuus A, Buth KJ, Pearson FG. Exercise oximetry versus spirometry in the assessment of risk prior to lung resection. Ann Thorac Surg. 1995;60:603–8.

    Article  CAS  PubMed  Google Scholar 

  92. Warner L, Bartlett KA, Charles SA, O’Brien LM. Use of pulse oximetry with exercise in the diagnosis of PCP. Int Conf AIDS. 1991;7:232.

    Google Scholar 

  93. Weiner DK, Turner GH, Hennon JG, Perera S, Hartmann S. The state of chronic pain education in geriatric medicine fellowship training programs: results of a national survey. J Am Geriatr Soc. 2005;53:1798–805.

    Article  PubMed  Google Scholar 

  94. Cayea D, Perera S, Weiner DK. Chronic low back pain in older adults: What physicians know, what they think they know, and what they should be taught. J Am Geriatr Soc. 2006;54:1772–7.

    Article  PubMed  Google Scholar 

  95. Mezei L, Murinson BB. Pain education in North American medical schools. J Pain. 2011;12:1199–208.

    Article  PubMed  Google Scholar 

  96. Morone NE, Weiner DK. Pain as the 5th vital sign: exposing the vital need for pain eduction. Clin Ther. 2013;35:1728–32.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Pergolizzi J. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin. 2013;29:1127–35.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Lord B, Woollard M. The reliability of vital signs in estimating pain severity among adult patients treated by paramedics. Emerg Med J. 2011;28:147e150.

    Article  Google Scholar 

  99. Stenestrand U, Wijkman M, Fredrikson M, Nystrom FH. Association between admission supine systolic blood pressure and 1-year mortality in patients admitted to the intensive care unit for acute chest pain. JAMA. 2010;303:1167–72.

    Article  CAS  PubMed  Google Scholar 

  100. Irfan A, Haaf P, Meissner J, Twerenbold R, Reiter M, Reichlin T, Schaub N, Zbinden A, Heinisch C, Drexler B, Winkler K, Mueller C. Systolic blood pressure at emergency department presentation and 1-year mortality in acute chest pain patients. Eur J Intern Med. 2011;22:495–500.

    Article  PubMed  Google Scholar 

  101. Hadjistavropoulos T, Von Baeyer C, Craig KD. Pain assessment in persons with limited ability to communicate. In: Handbook of pain assessment. Turk DC, Melzack R. editors. New York-London: The Guilford Press; 2001. p. 134–50.

    Google Scholar 

  102. Arboura C, Gélinasa C. Are vital signs valid indicators for the assessment of pain in postoperative cardiac surgery ICU adults? Intensive and Critical Care. Nursing. 2010;26:83–90.

    Google Scholar 

  103. Fowler M, Slater TM, Garza TH, Maani CV, DeSocio PA, Hansen JJ, McGhee LL. Relationships between early acute pain scores, autonomic nervous system function, and injury severity in wounded soldiers. J Trauma. 2011;71:S87–90.

    Article  PubMed  Google Scholar 

  104. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921–8.

    Article  PubMed  Google Scholar 

  105. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008;9:122–45.

    Article  PubMed  Google Scholar 

  106. Lubawski J, Saclarides T. Postoperative ileus: strategies for reduction. Ther Clin Risk Manag. 2008;4:913–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  107. Greisen J, Juhi CB, Grofte T, Vilstrup H, Jensen TS, Schmitz O. Acute pain induces insulin resistance in humans. Anesthesiology. 2001;95:578–84.

    Article  CAS  PubMed  Google Scholar 

  108. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109–17.

    Article  CAS  PubMed  Google Scholar 

  109. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87:62–72.

    Article  CAS  PubMed  Google Scholar 

  110. Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L. Measuring pain as the 5th vital sign does not improve quality of pain management. J Gen Intern Med. 2006;21:607–12.

    Article  PubMed  PubMed Central  Google Scholar 

  111. George SZ, Dannecker EA, Robinson ME. Fear of pain, not pain catastrophizing, predicts acute pain intensity, but neither factor predicts tolerance or blood pressure reactivity: an experimental investigation in pain-free individuals. Eur J Pain. 2006;10:457–65.

    Article  PubMed  Google Scholar 

  112. Williams ACdeC, Davies HTO, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain 2000; 85:457–463.

    Google Scholar 

  113. Berg I, Sjostrom B. A comparative study of nurses' and elderly patients ratings of pain and pain tolerance. J Gerontol Nurs. 1999;5:30–6.

    Article  Google Scholar 

  114. Aissaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, Abouqal R. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg. 2005;101:1470–6.

    Article  PubMed  Google Scholar 

  115. Ahlers SJGM, van Gulik L, van der Veen AM, van Dogen HPA, Bruins P, Belitser SV, de Boer A, Tibboel D, Knibbe CAJ. Comparison of different pain scoring systems in critically ill patients in a general ICU. Crit Care. 2008;12:R15.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Ahlers SJGM, van der Veen AM, van Dijk M, Tibboel D, Knibbe CAJ. The use of the behavioral pain scale to assess pain in conscious sedated patients. Anesth Analg. 2010;110:127–33.

    Article  PubMed  Google Scholar 

  117. Lorenz KA, Sherbourne CD, Shugarman LR, Rubenstein LV, Wen L, Cohen A, Goebel JR, Hagenmeier E, Simon B, Lanto A, Asch SM. How reliable is pain as the fifth vital sign? J Am Board Fam Med. 2009;22:291–8.

    Article  PubMed  Google Scholar 

  118. Gomes T, Mamdani MM, Paterson JM, Dhalla IA, Juulink DN. Trends in high-dose opioid prescribing in Canada. Can Fam Physician. 2014;60:826–32.

    PubMed  PubMed Central  Google Scholar 

  119. Sehgal N, Manchikanti L, Smith HS. Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician. 2012;15:ES67–92.

    PubMed  Google Scholar 

  120. Okie S. A flood of opioids, a rising tide of deaths. N Engl J Med. 2010;363(21):1981–5.

    Article  CAS  PubMed  Google Scholar 

  121. Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM, APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of. Pain Medicine. Acute pain management: scientific evidence. 3rd ed. Melbourne: ANZCA & FPM; 2010.

    Google Scholar 

  122. Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain. 1975;1:277–99.

    Article  CAS  PubMed  Google Scholar 

  123. Jensen MP, Mardekian J, Lakshminarayanan M, Boye ME. Validity of 24-h recall ratings of pain severity: biasing effects of “Peak” and “End” pain. Pain. 2008;137:422–7.

    Article  PubMed  Google Scholar 

  124. Aubrun G, Langeron O, Quesnel C, Coriat P, Riou B. Relationships between measurement of pain using visual analog score and morphine requirements during postoperative intravenous morphine titration. Anesthesiology. 2003;98:1415–21.

    Article  CAS  PubMed  Google Scholar 

  125. Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB. What decline in pain intensity is meaningful to patients with acute pain? Pain. 2003;105:151–7.

    Article  PubMed  Google Scholar 

  126. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407–14.

    Article  PubMed  Google Scholar 

  127. Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003;10:1128–30.

    Article  PubMed  Google Scholar 

  128. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL. Defining the clinically important difference in pain outcome measures. Pain. 2000;88:287–94.

    Article  CAS  PubMed  Google Scholar 

  129. Farrar JT, Young Jr JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58.

    Article  CAS  PubMed  Google Scholar 

  130. Murphy DF, McDonald A, Power C, Unwin A, MacSullivan R. Measurement of pain: a comparison of the visual analogue with a nonvisual analogue scale. Clin J Pain. 1987;3:191–7.

    Article  Google Scholar 

  131. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998;86:102–6.

    CAS  PubMed  Google Scholar 

  132. Breivik EK, Bjornsson GA, Skovlund E. A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain. 2000;16:22–8.

    Article  CAS  PubMed  Google Scholar 

  133. Myles PS, Troedel S, Boquest M, Reeves M. The pain visual analog scale: is it linear or nonlinear? Anesth Analg. 1999;89:1517–20.

    CAS  PubMed  Google Scholar 

  134. Myles PS, Urquhart N. The linearity of the visual analogue scale in patients with severe acute pain. Anaesth Intensive Care. 2005;33:54–8.

    CAS  PubMed  Google Scholar 

  135. Machata AM, Kabon B, Willschke H, Fassler K, Gustoff B, Marhofer P, Curatolo M. A new instrument for pain assessment in the immediate postoperative period. Anasthesia. 2009;64:392–8.

    Article  CAS  Google Scholar 

  136. Arif-Rahua M, Grap MJ. Facial expression and pain in the critically ill non-communicative patient: State of science review. Intensive Crit Care Nurs. 2010;26:343–52.

    Article  Google Scholar 

  137. Lucey P, Cohn JF, Matthews I, Lucey S, Sridharan S, Howlett J, Prkachin KM. Automatically Detecting Pain in Video Through Facial Action Units Journal Institute of Electrical and Electronics Engineers (IEEE). http://www.cs.cmu.edu/~jeffcohn/pubs/IEEE_SMC_Pain_2010_final.pdf.

  138. Zwakhalen SMG, Hamers JPH, Abu-Saad HH, Berger MPF. Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr. 2006;6:3. doi:10.1186/1471-2318-6-3.

    Article  PubMed  PubMed Central  Google Scholar 

  139. Royal College of Physicians, British Geriatrics Society and British Pain Society. The assessment of pain in older people: national guidelines. Concise guidance to good practice series, No 8. London: RCP; 2007.

    Google Scholar 

  140. World Health Organization. Traitement de la douleur cancéreuse. Geneva, Switz: World Health. Organization; 1987.

    Google Scholar 

  141. Ruddick W. Do doctors undertreat pain? Bioethics. 1997;11:248–55.

    Article  Google Scholar 

  142. Veysman BD. Prescriber’s narcophobia syndrome: physicians’ disease and patients’ misfortune. BMJ. 2009;339:b4987.

    Article  Google Scholar 

  143. MacIntyre PE, Walker S, Power I, Schug SA. Acute pain management: scientific evidence revisited. Br J Anaesth. 2006;96:1–4.

    Article  CAS  PubMed  Google Scholar 

  144. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery—a review of predictive factors. Anesthesiology. 2000;93:1123–33.

    Article  CAS  PubMed  Google Scholar 

  145. Macrae WA. Chronic pain after surgery. Br J Anaesth. 2001;87:88–98.

    Article  CAS  PubMed  Google Scholar 

  146. Leung L. From ladder to platform: a new concept for pain management. J Prim Health Care. 2012;4(3):254–8.

    PubMed  Google Scholar 

  147. Killian KJ. The objective measurement of breathlessness. Chest. 1985;88(2 Suppl):84S–90S.

    Article  CAS  PubMed  Google Scholar 

  148. Carrieri-Kohlman V, Douglas M, Murray Gormley J, Stulbarg M. Desensitization and guided mystery: treatment approaches for the management of dyspnea. Heart Lung. 1993;22:226–34.

    CAS  PubMed  Google Scholar 

  149. Gift AG, Plaut SM, Jacox A. Psychologic and physiologic factors related to dyspnea in subjects with chronic obstructive pulmonary disease. Heart Lung. 1986;15:595–601.

    CAS  PubMed  Google Scholar 

  150. Gift A, Cahill CA. Psychophysiologic aspects of dyspnea in chronic obstructive pulmonary disease: A pilot study. Heart Lung. 1990;19:252–7.

    CAS  PubMed  Google Scholar 

  151. Bailey PH. Dyspnea-anxiety-dyspnea cycle. COPD patients stories of breathlessness: “It’s scary when you can’t breathe”. Qual Health Res. 2004;14(6):760–78.

    Article  PubMed  Google Scholar 

  152. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2(2):92–8.

    CAS  PubMed  Google Scholar 

  153. Fletcher CM. (Chairman). Standardised questionnaire on respiratory symptoms: a statement prepared and approved by the MRC committee on the aetiology of chronic bronchitis (MRC breathlessness score). BMJ. 1960;2:1665.

    Google Scholar 

  154. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the medical research council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  155. O’Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk D, Balter M, et al. Canadian thoracic society recommendations for management of chronic obstructive pulmonary disease – 2003. Can Respir J. 2003;10(Suppl.A):11A–65A.

    Google Scholar 

  156. Asfar P, Meziani F, Hamel J-F, Grelon F, Megarbane B, SEPSISPAM investigators, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370:1583–93.

    Article  CAS  PubMed  Google Scholar 

  157. Jylhä M, Volpato S, Guralnik JM. Self-rated health showed a graded association with frequently used biomarkers in a large population sample. J Clin Epidemiol. 2006;59:465–71.

    Article  PubMed  Google Scholar 

  158. Meagher DJ. Delirium: optimising management. BMJ. 2001;322:144–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  159. Kiely DK, Jones RN, Bergmann MA, Marcantonio ER. Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci. 2007;62:174–9.

    Article  PubMed  Google Scholar 

  160. McNarry AF, Goldhill DR. Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale. Anaesthesia. 2004;59:34–7.

    Article  CAS  PubMed  Google Scholar 

  161. Clifford M, Ridley A, Gleeson M, Kellett J. The early mortality associated with agitation and sedation in acutely ill medical patients. Eur J Intern Med. 2013;24:e85.

    PubMed  Google Scholar 

  162. Bellelli G, Speciale S, Barisione E, Trabucchi M. Delirium subtypes and 1-year mortality among elderly patients discharged from a post-acute rehabilitation facility. J Gerontol A Biol Sci Med Sci. 2007;62:1182–3.

    Article  PubMed  Google Scholar 

  163. Inouye S, van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R. Clarifying confusion: the confusion assessment method. Ann Intern Med. 1990;113:941–8.

    Article  CAS  PubMed  Google Scholar 

  164. Hogan DB, MacKnight C, Bergman H. Steering Committee, Canadian initiative on frailty and aging. Models, definitions, and criteria of frailty [review]. Aging Clin Exp Res. 2003;15(3 Suppl):1–29.

    PubMed  Google Scholar 

  165. Rylance J, Baker T, Mushi E, Mashaga D. Use of an early warning score and ability to walk predicts mortality in medical patients admitted to hospitals in Tanzania. Trans R Soc Trop Med Hyg. 2009;103:790–4.

    Article  PubMed  Google Scholar 

  166. Wheeler I, Price C, Sitch A, et al. Early warning scores generated in developed healthcare settings are not sufficient at predicting early mortality in blantyre, malawi: a prospective cohort study. PLoS One. 2013;8(3):e59830. doi:10.1371/journal.pone.0059830.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  167. Opio MO, Nansubuga G, Kellett J. Validation of the VitalPACTM Early Warning Score (ViEWS) in acutely ill medical patients attending a resource-poor hospital in sub-Saharan Africa. Resuscitation. 2013;84:743–6.

    Article  PubMed  Google Scholar 

  168. Opio MO, Nansubuga G, Kellett J, Clifford M, Murray A. Performance of TOTAL, in medical patients attending a resource-poor hospital in sub-Saharan Africa and a small Irish rural hospital. Acute Med. 2013;12:135–40.

    CAS  PubMed  Google Scholar 

  169. Kellett J, Deane B, Gleeson M. Derivation and validation of a score based on hypotension, oxygen saturation, low temperature, ECG changes and loss of independence (HOTEL) that predicts early mortality between 15 minutes and 24 hours after admission to an acute medical unit. Resuscitation. 2008;78:52–8.

    Article  PubMed  Google Scholar 

  170. Brabrand M, Hallas J, Knudsen T. Loss of independence: a novel but important global marker of illness. Scandinavian J Trauma, Resuscitation Emerg Med. 2013;21(Suppl 2):A34. doi:10.1186/1757-7241-21-S2-A34.

    Article  Google Scholar 

  171. Brabrand M, Folkestad L, Clausen NG, Knudsen T, Hallas J. Risk scoring systems for adults admitted to the emergency department: a systematic review. Scandinavian J Trauma, Resuscitation and Emerg Med.

    Google Scholar 

  172. Rockwood K, Song X, MacKnight CA, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  173. Brabrand M, Kellett J. Mobility measures should be added to the national early warning score (NEWS). Resuscitation. 2014;85:e151.

    Article  PubMed  Google Scholar 

  174. Wallis PA, Gottschalk SB, Wood D, et al. The cape triage score - a triage system for South Africa. S Afr Med J. 2006;96:53–6.

    Google Scholar 

  175. Wallis LA, Balfour CH. Triage in emergency departments. S Afr Med J. 2007;97:13.

    PubMed  Google Scholar 

  176. Bogardus ST, Towle V, Williams CS, Desai MM, Inouye SK. What does the medical record reveal about functional status? J Gen Intern Med. 2001;16:728–36.

    Article  PubMed  PubMed Central  Google Scholar 

  177. Hirdes JP, Ljunggren G, Morris JN, Frijters DHM, Soveri HF, Gray L, Björkgren M, Gilgen R. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277. doi:10.1186/1472-6963-8-277.

    Article  PubMed  PubMed Central  Google Scholar 

  178. Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003;51:314–22.

    Article  PubMed  Google Scholar 

  179. Kellett J, Clifford M, Ridley A, Murray A, Gleeson M. A four item scale based on gait for the immediate global assessment of acutely ill medical patients – one look is more than 1000 words. Eur Geriatr Med. 2014;5:92–6.

    Google Scholar 

  180. Karnik K, Mazzatti DJ. Review of tools and technologies to assess multi-system functional impairment and frailty. Clin Medicine: Geriatric. 2009;31–8.

    Google Scholar 

  181. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI, Kellett J, Deane B, Higgins B. Should age be included as a component of track and trigger systems used to identify sick adult patients? Resuscitation. 2008;78:109–15.

    Article  PubMed  Google Scholar 

  182. Opio MO, Nansubuga G, Kellett J. In-hospital mortality of acutely ill medical patients admitted to a resource poor hospital in sub-Saharan Africa and to a Canadian regional hospital compared using the abbreviated VitalPAC™ early warning score. Eur J Intern Med. 2014;25:142–6.

    Article  PubMed  Google Scholar 

  183. Prytherch DR, Smith GB, Schmidt PE, Featherstone PI. ViEWS—towards a national early warning score for detecting adult inpatient deterioration. Resuscitation. 2010;81:932–7.

    Article  PubMed  Google Scholar 

  184. Latré B et al. A survey on wireless body area networks. Wireless Networks. 2011;17(1):1–18.

    Article  Google Scholar 

  185. Kellett J. Will continuous surveillance monitoring of vital signs provide cheaper, safer, and better hospital care for all? Jt Comm J Qual Patient Saf. 2012;38:426–7.

    Article  PubMed  Google Scholar 

  186. Kellett J, Murray A, Woodworth S, Huang W. Trends in weighted vital signs and the clinical course of 44,531 acutely ill medical patients while in hospital. Acute Med. 2015;14:4–10.

    Google Scholar 

  187. Kellett J, Woodworth S, Wang F, Huang W. Changes and their prognostic implications in the abbreviated VitalPACTM early warning score (ViEWS) after admission to hospital of 18,853 acutely ill medical patients. Resuscitation. 2013;84:13–20.

    Article  PubMed  Google Scholar 

  188. Murray A, Kellett J, Huang W, Woodworth S, Wang F. Trajectories of the averaged abbreviated VitalpacTM early warning score (AbEWS) and clinical course of 44,531 consecutive admissions hospitalized for acute medical illness. Resuscitation. 2014;85:544–8.

    Article  PubMed  Google Scholar 

  189. Kellett J, Murray A. How to follow the NEWS. Acute Med. 2014;13:104–7.

    PubMed  Google Scholar 

  190. Hravnak M, Edwards L, Clontz A, Valenta C, DeVita MA, Pinsky MR. Defining the incidence of cardiorespiratory instability in patients in step-down units using an electronic integrated monitoring system. Arch Intern Med. 2008;168:1300–8.

    Article  PubMed  PubMed Central  Google Scholar 

  191. Kellett J, Rasool S. The prediction of the in-hospital mortality of acutely ill medical patients by electrocardiogram (ECG) dispersion mapping compared with established risk factors and predictive scores — A pilot study. Eur J Intern Med. 2011;22:394–8.

    Google Scholar 

  192. Kellett J, Emmanuel A, Rasool S. The prediction by ECG dispersion mapping of clinical deterioration, as measured by increase in the simple clinical score. Acute Med. 2012;11:8–12.

    CAS  PubMed  Google Scholar 

  193. Lin S, Yokoyama H, Rac VE, Brooks SC. Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review. Resuscitation. 2012;83:684–91.

    Article  CAS  PubMed  Google Scholar 

  194. Nickel CH, Messmer AS, Geigy N, Misch F, Mueller B, Dusemund F, Hertel S, Hartmann O, Giersdorf S, Bingisser R. Stress markers predict mortality in patients with nonspecific complaints presenting to the emergency department and may be a useful risk stratification tool to support disposition planning. Acad Emerg Med. 2013;20:670–9.

    Article  PubMed  Google Scholar 

  195. Prytherch DR, Sirl JS, Schmidt P, et al. The use of routine laboratory data to predict in-hospital death in medical admissions. Resuscitation. 2005;66:203–7.

    Article  CAS  PubMed  Google Scholar 

  196. Froom P, Shimoni Z. Prediction of hospital mortality rates by admission laboratory tests. Clin Chem. 2006;52:325–8.

    Article  CAS  PubMed  Google Scholar 

  197. Asadollahi K, Hastings IM, Gill GV, et al. Prediction of hospital mortality from admission laboratory data and patient age: a simple model. Emerg Med Aust. 2011;23:354–63.

    Article  Google Scholar 

  198. Loekito E, Bailey J, Bellomo R, Hart GK, Hegarty C, Davey P, Bain C, Pilcher D, Schneider H. Common laboratory tests predict imminent death in ward patients. Resuscitation. 2013;84:280–5.

    Article  PubMed  Google Scholar 

  199. Silke B, Kellett J, Rooney T, Bennett K, O'Riordan D. An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling. QJM. 2010;103:23–32.

    Article  CAS  PubMed  Google Scholar 

  200. Brabrand M, Knudsen T, Hallas J. Identifying admitted patients at risk of dying: a prospective observational validation of four biochemical scoring systems. BMJ Open. 2013;3:e002890.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

The author would like to acknowledge the assistance and cooperation of Kristi Taylor and Dawn Bubar of the Thunder Bay Regional Health Sciences Center information technology department. He would also like to thank Dr Martin Opio, Kitovu Hospital, Masaka, Uganda, and Dr Mikkel Brabrand, Department of Medicine, Sydvestjysk Sygehus, Esbjerg, Denmark, for their help and advice.

Conflict of interest Dr John Kellett is a director and chief medical officer of Tapa Healthcare DAC, Dundalk, Ireland.

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Kellett, J. (2017). The Assessment and Interpretation of Vital Signs. In: DeVita, M., et al. Textbook of Rapid Response Systems. Springer, Cham. https://doi.org/10.1007/978-3-319-39391-9_8

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