eprintid: 17831 rev_number: 8 eprint_status: archive userid: 2 dir: disk0/00/01/78/31 datestamp: 2025-09-04 23:30:11 lastmod: 2025-09-04 23:30:12 status_changed: 2025-09-04 23:30:11 type: article metadata_visibility: show creators_name: López-Izquierdo, Raúl creators_name: Ingelmo-Astorga, Elisa A. creators_name: del Pozo Vegas, Carlos creators_name: Gracia Villar, Santos creators_name: Dzul López, Luis Alonso creators_name: Aparicio Obregón, Silvia creators_name: Calderón Iglesias, Rubén creators_name: Sanz-García, Ancor creators_name: Martín-Rodríguez, Francisco creators_id: creators_id: creators_id: creators_id: santos.gracia@uneatlantico.es creators_id: luis.dzul@uneatlantico.es creators_id: silvia.aparicio@uneatlantico.es creators_id: ruben.calderon@uneatlantico.es creators_id: creators_id: title: Association between blood cortisol levels and numerical rating scale in prehospital pain assessment ispublished: pub subjects: uneat_bm divisions: uneatlantico_produccion_cientifica divisions: unincol_produccion_cientifica divisions: uninimx_produccion_cientifica divisions: uninipr_produccion_cientifica divisions: unic_produccion_cientifica divisions: uniromana_produccion_cientifica full_text_status: public keywords: Diagnostic markers; Pain abstract: Background Nowadays, there is no correlation between levels of cortisol and pain in the prehospital setting. The aim of this work was to determine the ability of prehospital cortisol levels to correlate to pain. Cortisol levels were compared with those of the numerical rating scale (NRS). Methods This is a prospective observational study looking at adult patients with acute disease managed by Emergency Medical Services (EMS) and transferred to the emergency department of two tertiary care hospitals. Epidemiological variables, vital signs, and prehospital blood analysis data were collected. A total of 1516 patients were included, the median age was 67 years (IQR: 51–79; range: 18–103) with 42.7% of females. The primary outcome was pain evaluation by NRS, which was categorized as pain-free (0 points), mild (1–3), moderate (4–6), or severe (≥7). Analysis of variance, correlation, and classification capacity in the form area under the curve of the receiver operating characteristic (AUC) curve were used to prospectively evaluate the association of cortisol with NRS. Results The median NRS and cortisol level are 1 point (IQR: 0–4) and 282 nmol/L (IQR: 143–433). There are 584 pain-free patients (38.5%), 525 mild (34.6%), 244 moderate (16.1%), and 163 severe pain (10.8%). Cortisol levels in each NRS category result in p < 0.001. The correlation coefficient between the cortisol level and NRS is 0.87 (p < 0.001). The AUC of cortisol to classify patients into each NRS category is 0.882 (95% CI: 0.853–0.910), 0.496 (95% CI: 0.446–0.545), 0.837 (95% CI: 0.803–0.872), and 0.981 (95% CI: 0.970–0.991) for the pain-free, mild, moderate, and severe categories, respectively. Conclusions Cortisol levels show similar pain evaluation as NRS, with high-correlation for NRS pain categories, except for mild-pain. Therefore, cortisol evaluation via the EMS could provide information regarding pain status. date: 2025-07 publication: Communications Medicine volume: 5 number: 1 id_number: doi:10.1038/s43856-025-01020-4 refereed: TRUE issn: 2730-664X official_url: http://doi.org/10.1038/s43856-025-01020-4 access: open language: en citation: Artículo Materias > Biomedicina Universidad Europea del Atlántico > Investigación > Producción Científica Fundación Universitaria Internacional de Colombia > Investigación > Producción Científica Universidad Internacional Iberoamericana México > Investigación > Producción Científica Universidad Internacional Iberoamericana Puerto Rico > Investigación > Artículos y libros Universidad Internacional do Cuanza > Investigación > Producción Científica Universidad de La Romana > Investigación > Producción Científica Abierto Inglés Background Nowadays, there is no correlation between levels of cortisol and pain in the prehospital setting. The aim of this work was to determine the ability of prehospital cortisol levels to correlate to pain. Cortisol levels were compared with those of the numerical rating scale (NRS). Methods This is a prospective observational study looking at adult patients with acute disease managed by Emergency Medical Services (EMS) and transferred to the emergency department of two tertiary care hospitals. Epidemiological variables, vital signs, and prehospital blood analysis data were collected. A total of 1516 patients were included, the median age was 67 years (IQR: 51–79; range: 18–103) with 42.7% of females. The primary outcome was pain evaluation by NRS, which was categorized as pain-free (0 points), mild (1–3), moderate (4–6), or severe (≥7). Analysis of variance, correlation, and classification capacity in the form area under the curve of the receiver operating characteristic (AUC) curve were used to prospectively evaluate the association of cortisol with NRS. Results The median NRS and cortisol level are 1 point (IQR: 0–4) and 282 nmol/L (IQR: 143–433). There are 584 pain-free patients (38.5%), 525 mild (34.6%), 244 moderate (16.1%), and 163 severe pain (10.8%). Cortisol levels in each NRS category result in p < 0.001. The correlation coefficient between the cortisol level and NRS is 0.87 (p < 0.001). The AUC of cortisol to classify patients into each NRS category is 0.882 (95% CI: 0.853–0.910), 0.496 (95% CI: 0.446–0.545), 0.837 (95% CI: 0.803–0.872), and 0.981 (95% CI: 0.970–0.991) for the pain-free, mild, moderate, and severe categories, respectively. Conclusions Cortisol levels show similar pain evaluation as NRS, with high-correlation for NRS pain categories, except for mild-pain. Therefore, cortisol evaluation via the EMS could provide information regarding pain status. metadata López-Izquierdo, Raúl; Ingelmo-Astorga, Elisa A.; del Pozo Vegas, Carlos; Gracia Villar, Santos; Dzul López, Luis Alonso; Aparicio Obregón, Silvia; Calderón Iglesias, Rubén; Sanz-García, Ancor y Martín-Rodríguez, Francisco mail SIN ESPECIFICAR, SIN ESPECIFICAR, SIN ESPECIFICAR, santos.gracia@uneatlantico.es, luis.dzul@uneatlantico.es, silvia.aparicio@uneatlantico.es, ruben.calderon@uneatlantico.es, SIN ESPECIFICAR, SIN ESPECIFICAR (2025) Association between blood cortisol levels and numerical rating scale in prehospital pain assessment. Communications Medicine, 5 (1). ISSN 2730-664X document_url: http://repositorio.unib.org/id/eprint/17831/1/s43856-025-01020-4.pdf