Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: a retrospective cohort study
Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: a retrospective cohort study
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DOI：
10.1097/j.pain.0000000000000693
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发表时间：
2016-12-01
期刊：
影响因子：
7.4
通讯作者：
Lambert, Bruce L.
中科院分区：
文献类型：
--
作者：
Kannampallil, Thomas;Galanter, William L.;Lambert, Bruce L.
住院患者的疼痛护理往往是次优的。将疼痛评分表示为图形轨迹可以提供对疼痛的理解和治疗的见解。我们描述了一项为期1年的回顾性观察性研究，以描述在城市学术医疗中心入院后前48小时内住院成人的疼痛轨迹。使用一组出现明显疼痛的患者（疼痛评分>4; n = 7762次），我们描述了疼痛轨迹并测量了曲线下面积、入院后前2小时的轨迹斜率和平台期疼痛强度。我们使用混合效应回归来评估疼痛评分与社会人口统计学（年龄，种族和性别），疼痛药物治疗顺序（阿片类药物，非阿片类药物和无药物）和医疗服务（产科，精神病学，外科，镰状细胞，重症监护病房和医学）之间的关联。使用K均值聚类来识别具有相似轨迹的患者亚组。轨迹显示基于种族、性别、服务和初始疼痛评分的差异。假定有不同疼痛经历的患者（例如，镰刀与产科）有明显不同的疼痛轨迹。初始疼痛较高的患者在治疗的前2小时内疼痛减轻更快。在入院后48小时内实现的疼痛减轻约为初始疼痛的50%，无论初始疼痛如何。大多数患者的疼痛未能完全解决，在疼痛评分为4或更高时达到稳定。将疼痛评分可视化为图形轨迹，说明了疼痛的动态变化，突出显示了观察期间的疼痛反应，并可能为质量改进和研究提供新的见解。
Pain care for hospitalized patients is often suboptimal. Representing pain scores as a graphical trajectory may provide insights into the understanding and treatment of pain. We describe a 1-year, retrospective, observational study to characterize pain trajectories of hospitalized adults during the first 48 hours after admission at an urban academic medical center. Using a subgroup of patients who presented with significant pain (pain score >4; n = 7762 encounters), we characterized pain trajectories and measured area under the curve, slope of the trajectory for the first 2 hours after admission, and pain intensity at plateau. We used mixed-effects regression to assess the association between pain score and sociodemographics (age, race, and gender), pain medication orders (opioids, nonopioids, and no medications), and medical service (obstetrics, psychiatry, surgery, sickle cell, intensive care unit, and medicine). K-means clustering was used to identify patient subgroups with similar trajectories. Trajectories showed differences based on race, gender, service, and initial pain score. Patients presumed to have dissimilar pain experiences (eg, sickle vs obstetrical) had markedly different pain trajectories. Patients with higher initial pain had a more rapid reduction during their first 2 hours of treatment. Pain reduction achieved in the 48 hours after admission was approximately 50% of the initial pain, regardless of the initial pain. Most patients' pain failed to fully resolve, plateauing at a pain score of 4 or greater. Visualizing pain scores as graphical trajectories illustrates the dynamic variability in pain, highlighting pain responses over a period of observation, and may yield new insights for quality improvement and research.