Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montreal, Quebec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada.
Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montreal, Quebec, Canada.
Ann Emerg Med. 2019 Aug;74(2):224-232. doi: 10.1016/j.annemergmed.2019.01.019. Epub 2019 Feb 21.
The objective of the study is to evaluate the acute pain intensity evolution in emergency department (ED) discharged patients, using group-based trajectory modeling. This method identifies patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups.
This was a prospective cohort study of ED patients aged 18 years or older, with an acute pain condition (≤2 weeks), and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (numeric rating scale of 0 to 10) and pain medication use.
Among the 372 included patients, 6 distinct post-ED pain intensity trajectories were identified. Two started with severe levels of pain; one remained with severe pain intensity (12.6% of the sample) and the other ended with a moderate pain intensity level (26.3%). Two other trajectories had severe initial pain; one decreased to mild pain (21.7%) and the other to no pain (13.8%). Another trajectory had moderate initial pain that decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day period (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and opioid consumption.
Acute pain resolution after an ED visit seems to progress through 6 different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.
本研究旨在使用基于群组的轨迹建模评估急诊科（ED）出院患者的急性疼痛强度演变。该方法可识别具有相似时间变化特征的患者群组，而无需假设存在特定模式或群组数量。
这是一项前瞻性队列研究，纳入年龄在 18 岁及以上、有急性疼痛（≤2 周）且携带阿片类药物处方出院的 ED 患者。患者完成了为期 14 天的日记，评估每日疼痛强度水平（0 至 10 的数字评分量表）和疼痛药物使用情况。
在 372 名纳入患者中，确定了 6 种不同的 ED 后疼痛强度轨迹。其中 2 种起始时疼痛程度严重；1 种持续存在严重疼痛强度（占样本的 12.6%），另 1 种结束时疼痛强度为中度（26.3%）。另外 2 种轨迹起始时疼痛严重，1 种降至轻度疼痛（21.7%），另 1 种降至无痛（13.8%）。另一种轨迹起始时疼痛中度，降至轻度（15.9%），最后一种起始时疼痛轻度，14 天结束时无痛（9.7%）。疼痛轨迹模式与年龄、疼痛类型、ED 出院时的疼痛强度和阿片类药物消耗显著相关。
ED 就诊后急性疼痛的缓解似乎通过 6 种不同的轨迹模式进展，这些模式比简单的线性模型更具信息性，并且可能有助于在未来的研究中调整急性疼痛管理。
