The CRAP Score
(Canadian Relativity Adjusted Pain Score)
via allnurses.com
CRAP=(OPS+AF)(SC)(EC)
OPS=Old Pain Score
AF=Adjustment Factor
SC=Story Credibility
EC=Exam Credibility
The key value here is the Adjustment Factor. For "LPT" patients (Low Pain Threshold) this will be calculated as follows:
When you enter the room he is yelling at someone on his cell phone and eating Cheetos, but tells you, "This is a bad one doc." On exam his VS are normal and his abdomen and back are both tender. "I didn't even notice they were hurting," he says. His CRAP score would be (10-6-2-5-5-1)(0.5)(1) which would be negative 4.5, but since his number is negative, you decide to leave out the credibility conversion for a score of negative 9.
You tell him that pain medications are not indicated for his headache because his CRAP score in negative 9 and he can go home whenever he is ready.
Thanks to the anonymous commenter for the great find.
via allnurses.com
CRAP=(OPS+AF)(SC)(EC)
OPS=Old Pain Score
AF=Adjustment Factor
SC=Story Credibility
EC=Exam Credibility
The key value here is the Adjustment Factor. For "LPT" patients (Low Pain Threshold) this will be calculated as follows:
- For every point over 10 which the patient reports, subtract one. If they say their pain is a "12" then subtract 2 points and start with an 8.
- For every visit the patient has had to your ER in the past 12 months for a painful condition that was either chronic or went undiagnosed, subtract 1 point.
- If you push on a non-painful or uninjured area of the patient's body, the shin for example, and they say "Ouch", subtract 1 point.
- For every allergy to a non-narcotic medication that could be effective for their condition, subtract 1 point.
- If they are wearing sunglasses, subtract 1 point.
- If they still have tape or EKG lead residue on their body from a prior hospital visit, subtract 2 points.
- If a spouse or family member forced them to come in, add 1 point.
- If you check their records, and every time they've come to your ER for a painful condition something was torn, broken, ischemic, or perforated, add 2 points.
- If they have no allergies add 1 point.
- If they are tachycardic or hypertensive add 1 point.
When you enter the room he is yelling at someone on his cell phone and eating Cheetos, but tells you, "This is a bad one doc." On exam his VS are normal and his abdomen and back are both tender. "I didn't even notice they were hurting," he says. His CRAP score would be (10-6-2-5-5-1)(0.5)(1) which would be negative 4.5, but since his number is negative, you decide to leave out the credibility conversion for a score of negative 9.
You tell him that pain medications are not indicated for his headache because his CRAP score in negative 9 and he can go home whenever he is ready.
Thanks to the anonymous commenter for the great find.
Labels: links to greatness, pain
posted by scalpel at 10:34 AM
18 Comments:
Love it!!!
HA HA HA HA HA
Another deduction:
if they say "ohh ouch!" when you put the tourniquet on to start an IV and/or inflate the BP cuff: subtract 2 points.
I printed this out and took it to work about a month and a half ago.
I want to use it quite often... especially for the 10/10 paineurs that can ask for a sandwich, something to drink, and scream at the boyfriend/girlfriend on the cell for not being with them in their time of neeeeeeeeeeeeeeeeeeeed.
Dating tip:
If your girlfriend/boyfriend has to go to the emergency room more than 1-2 times a year when there is no visible injury/deformity/squirting blood then turn and run away as fast as you can or you are a fool
Um...when you're already in so much pain from the Fibro, that BP cuff can be sooooo painful. Don't get me started on the finger prick! It may not hurt so bad with some juice though.
I would add two for anyone with a HPT who has a grossly deformed limb. I would subtract two or three for anyone who presents with pain from something like a hangnail (regardless of how it looks) or if they are dialing a "1800LAWYER" number as you enter the room.
I just started my surgery rotation and I am in disbelief at some people's perception of pain. One guy was sitting in the SICU with peritonitis and was asking if he really needed an e-lap to discover the cause (yes sir, you do). Meanwhile, upstairs, a guy who had an I&D for a 2-centimeter-wide area of inflammation (I can hardly call it an abscess, but my attending told me to open it, so whatever) tells me his pain is an 8.
Me: "So the scale is, 0 is no pain, 10 is I'm cutting your leg off with a dull rusty letter opener. Tell me where you fit on that scale right now."
Him: "Oh. Um. A 7, then, at least." (slurping his 7-Up while changing the channel on his TV)
I like this one a lot better than the delta-p. Now you're thinking! Someone near and dear to me likes to answer "11" or "14". Though I know they are in pain, if they can't take the meaning of a scale seriously they shouldn't expect the physician to take them seriously either. I do wonder why people fail to understand that it is important to give ACCURATE information to someone trying to troubleshoot, whether it's your body or a computer. Sending your help on a wild goose chase is just dumb.
CRAP score.... I love it! Now, if you can just get the good ole Joint to mandate it......
Hilarious Scalpel! :)
Before I read the medblogs , thus more enlightened...I had occasionally exaggerated my pain score to emphasize how awful I really felt.
Here I worked with ER for 20 years and that one got by me.
But for those of us who have legitimate pain and did this...we just didn't get it..the importance of the numbers.
I did that with my urologist one night when describing the level of discomfort when I knew I needed a foley cath and the nurses didn't think I did. (I put out 1000 cc)I told him ..oh I don't remember now either 12, 16 or 25. (I've used them all) Anyway..since reading the med blogs..I understand that tiny wince he showed as he continued with the conversation. :)
My 10 is a stuck kidney stone.
My most recent awful was pain was a 7 with renal colic. Only then would I acknowledge that it was time to call the urodoc..denial and all that. :)
But what was making me squirrelly because I had to use pain meds in hospital (and now) because of being blocked and then stented..that when the pain goes down to between a 2-4..I hated asking for a percocet. 5 no problem.. But what I realized for me..that living with a ureteral stent 24/7...it causes discomfort/pain intermittently in varying degrees. And even though I now know you all don't really think of it as pain until it is a 5 (which is subjective)I find that I just have to get away from the bladder spasms, flank aching and over all ugh feeling being stented creates.
SeaSpray- For God's sake, you seem like a nice girl, but roaming from med blog to medblog spouting about all the things that ail you is getting pretty old. I feel like I know more about your health problems than I do my wife's! There's a reason nobody bites on your comments. It's not about your pain. It's about the post.
I apologize anonymous 02:44pm..to you and anyone else I may have annoyed/worn out with my tedious recounts of urological issues over these last couple of years.
I have tried to comment in response to the post topic, but admittedly...brevity with words is not my strong suit as you must be well aware..and so I have gotten away from the topic at times.
That being said..I do think my comment to this post connects in that I was explaining why I and probably others exaggerated the pain scale to emphasize the level of pain...not knowing how annoying it is to med people.
But I feel like I learned something important that I was struggling with recently in terms of taking narcotics..in and out of the hospital.
Knowing how you look at the pain scale..5 and up being worthy of pain meds and yet in the hospital..I requested it when I was what i considered a 2-4..and it was BOTHERING me because I am ever mindful of potential abuse of pain meds. BUT...I realized that with these stents...the pain might not always be 5-10..but it wears you out with the spasms and various feelings with it even when they aren't always strong ones when it is 24/7 and you just need to get away from it.
I think THAT is important to know and maybe someone else out there might be relieved that they might not always meet up to the pain scale criteria..but that doesn't negate the fact that they may need the meds depending upon their individual circumstances. It helped me to realize that.
I love the med blogosphere and appreciate the friendships that I've made. I would never intentionally want to alienate anyone..with anything I say...particularly ad nauseam.
And it's been cathartic to vent or share (but I could save it for MY blog)and I've learned so much and gotten wonderful support and hope I have been supportive of others.
You might be surprised to know the REAL reason I peruse the med blogs...For the EXQUISITE HUMOR!
But you know, I know people don't want to hear anyone's medical tales of woe repeatedly. We grow up learning that.
I let my hair down here because (med blogs)because it is medical.
And perhaps it not so much that I mention a medical story but that I give too many details and too long...and for many they are repetitive??
So I will try to be mindful of that. I will still comment in urostream because she is a urologist and most recently I was thrilled to see some dialog back and forth regarding ureteral stents.
And..actually I really am more about the humor. My SeaSpray blog probably has more humor than anything (says me)and yes it could also be referred to as the PeaSpray blog because it is my way to vent about these frustrating urological issues..but it's not just that. So ...anonymous...if you haven't been there and your not offended or annoyed by Bajingoland, grabbing the girls, whizzie winkles, or Milk of Magnesia-Versed cocktails... then you may appreciate the humor. But be forewarned because of my recent urology experiences..much of the current humor revolves around medical experiences.
Thank you for your constructive criticism and thank you for the "nice girl" comment. I like to think so. :)
P.S. I do comment in blogs about other things though. No one always does things or never does things.
And when you see my name like the tv..change the channel..but hopefully..That won't be necessary. :)
I said brevity wasn't my strong suit. :)
"If they are tachycardic or hypertensive add 1 point."
If they are bradycardic or hypotensive? add 2 points? skip to workup as unstable?
I was wondering how negative someone could be on this scale. This could be something to wager on, like BAC.
There may need to be more room for flexibility in the numbers, such as chatting on the cell phone, eating, drinking, carrying on with visitors, sudden worsening of symptoms when aware of being observed, . . . , but it does a very nice job of putting things in perspective quickly.
Jeez, Seaspray... way to keep it short.
good work ... great goin... visit mine...link1
Wonderful! I must use this one at work.
*LOUD APPLAUSE*
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