Tanenbaum Hilary C, Lawless Anna, Sy Lina S, Hong Vennis, Ackerson Bradley, Bruxvoort Katia, Luo Yi, Tseng Hung Fu
Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA.
J Pain Res. 2020 Jul 13;13:1757-1762. doi: 10.2147/JPR.S255238. eCollection 2020.
Post-herpetic neuralgia (PHN) is a common herpes zoster (HZ) complication, where pain persists 90 days after the initial HZ diagnosis. Evaluating PHN risk is essential for determining the burden on patients and health-care systems, but research shows variable estimates. The extent to which these differences are related to the assessment method has not been examined. The purpose of this study is to compare the proportion of PHN among HZ patients measured by medical chart review and self-report surveys.
PHN risk was assessed among a sample of Kaiser Permanente Southern California members with HZ. Chart reviews identified lingering pain 90-180 days post-HZ diagnosis and the Zoster Brief Pain Inventory was administered 90 days post-HZ diagnosis by telephone. Frequencies of PHN identified with each approach were cross-tabulated and stratified by sex, age group, and zoster vaccine live vaccination status.
Chart review and self-report were largely concordant (n=875, 89.20%); however, chart review yielded lower PHN risk overall and for the stratified subgroups. PHN from self-report was substantially higher (6.30-8.33%) among patients who were male, ≥70 years, or unvaccinated. Among those who typically seek care more often (female, younger, vaccinated), the discrepancy between each method was notably lower (1.60-2.92%).
Our findings suggest that chart review underestimates cases among those less likely to seek health care, including males, the elderly, and unvaccinated individuals. The agreement between the methods indicates that each can provide a reasonable approximation of PHN, but analyses should carefully control for health-care utilization.
带状疱疹后神经痛（PHN）是一种常见的带状疱疹（HZ）并发症，疼痛在初次诊断HZ后持续90天。评估PHN风险对于确定患者和医疗保健系统的负担至关重要，但研究显示估计值存在差异。这些差异与评估方法的相关程度尚未得到研究。本研究的目的是比较通过病历审查和自我报告调查测量的HZ患者中PHN的比例。
在南加州凯撒医疗机构患有HZ的成员样本中评估PHN风险。病历审查确定HZ诊断后90 - 180天的持续性疼痛，并在HZ诊断后90天通过电话进行带状疱疹简明疼痛量表调查。每种方法确定的PHN频率进行交叉制表，并按性别、年龄组和带状疱疹活疫苗接种状况分层。
病历审查和自我报告在很大程度上是一致的（n = 875，89.20%）；然而，病历审查总体上以及分层亚组的PHN风险较低。自我报告的PHN在男性、≥70岁或未接种疫苗的患者中显著更高（6.30 - 8.33%）。在那些通常就诊更频繁的人群（女性、年轻、接种疫苗）中，每种方法之间的差异明显更低（1.60 - 2.92%）。
我们的研究结果表明，病历审查低估了那些不太可能寻求医疗保健的人群中的病例，包括男性、老年人和未接种疫苗的个体。两种方法之间的一致性表明，每种方法都可以提供PHN的合理近似值，但分析应仔细控制医疗保健利用情况。
