The University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada.
Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 112 street, Edmonton T6G 2T4, Canada.
Am J Emerg Med. 2021 Jul;45:37-41. doi: 10.1016/j.ajem.2021.02.049. Epub 2021 Feb 23.
After initial emergency department (ED) management of acute renal colic, recurrent or ongoing severe pain is the usual pathway to ED revisits, hospitalizations and rescue interventions. If index visit pain severity is associated with stone size or with subsequent failure of conservative management, then it might be useful in identifying patients who would benefit from early definitive imaging or intervention. Our objectives were to determine whether pain severity correlates with stone size, and to evaluate its utility in predicting important outcomes.
We used administrative data and structured chart review to study all ED patients with CT proven renal colic at six hospitals in two cities over one-year. Triage nurses recorded arrival numeric rating scale (NRS) pain scores. We excluded patients with missing pain assessments and stratified eligible patients into severe (NRS 8-10) and less-severe pain groups. Stone parameters were abstracted from imaging reports, while hospitalizations and interventions were identified in hospital databases. We determined the classification accuracy of pain severity for stones >5mm and used multivariable regression to determine the association of pain severity with 60-day treatment failure, defined by hospitalization or rescue intervention.
We studied 2206 patients, 68% male, with a mean age of 49 years. Severe pain was 52.0% sensitive and 45.3% specific for larger stones >5mm. After multivariable adjustment, we found a weak negative association (adjusted OR =0.96) between pain severity and stone width. For each unit of increasing pain, the odds of a larger stone fell by 4%. Index visit pain severity was not associated with the need for hospitalization or rescue intervention within 60-days.
Pain severity is not helpful in predicting stone size or renal colic outcomes. More severe pain does not indicate a larger stone or a worse prognosis.
急性肾绞痛在急诊科（ED）初步治疗后，复发或持续严重疼痛通常是 ED 再次就诊、住院和抢救干预的途径。如果就诊时的疼痛严重程度与结石大小或随后保守治疗失败相关，那么它可能有助于识别那些将从早期明确的影像学或干预中受益的患者。我们的目的是确定疼痛严重程度是否与结石大小相关，并评估其在预测重要结局方面的效用。
我们使用行政数据和结构化病历回顾，研究了在两个城市的六家医院中，一年内通过 CT 证实患有肾绞痛的所有 ED 患者。分诊护士记录了到达时的数字评分量表（NRS）疼痛评分。我们排除了疼痛评估缺失的患者，并将符合条件的患者分为严重（NRS 8-10）和轻度疼痛组。结石参数从影像学报告中提取，而住院和干预则在医院数据库中确定。我们确定了疼痛严重程度对 >5mm 结石的分类准确性，并使用多变量回归来确定疼痛严重程度与 60 天治疗失败（定义为住院或抢救干预）的关联。
我们研究了 2206 名患者，其中 68%为男性，平均年龄为 49 岁。严重疼痛对 >5mm 的较大结石的敏感性为 52.0%，特异性为 45.3%。在多变量调整后，我们发现疼痛严重程度与结石宽度之间存在微弱的负相关（调整后的 OR=0.96）。疼痛每增加一个单位，结石较大的可能性就降低 4%。就诊时的疼痛严重程度与 60 天内住院或抢救干预的需求无关。
疼痛严重程度无助于预测结石大小或肾绞痛结局。更严重的疼痛并不表示结石更大或预后更差。
