犬截肢后疼痛（CAMPPAIN）计划：回顾性研究和诊断量表的制定。

The Canine Postamputation Pain (CAMPPAIN) initiative: a retrospective study and development of a diagnostic scale.

机构信息

Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA.

出版信息

Vet Anaesth Analg. 2021 Nov;48(6):861-870. doi: 10.1016/j.vaa.2021.07.003. Epub 2021 Aug 13.

DOI:10.1016/j.vaa.2021.07.003

PMID:34483040

Abstract

OBJECTIVE

To develop a scale to diagnose and assess the severity of postamputation pain (PAP) in dogs.

STUDY DESIGN

Single-center retrospective study.

ANIMALS

A total of 66 dogs that underwent thoracic or pelvic limb amputation and 139 dogs that underwent tibial plateau leveling osteotomy (TPLO) at a veterinary teaching hospital.

METHODS

An online survey regarding postoperative behavioral changes was sent to owners. Categorical, multiple-choice responses were entered into a univariable logistic regression model and tested for association with amputation using the Wald test. If p < 0.2, variables were forwarded to a multivariable logistic regression model for manual build. Model simplicity and predictive ability were optimized using the area under the receiver operating curve (AUROC) characteristic, and model calibration was assessed using the Hosmer-Lemeshow test. The selected model was converted to an integer scale (0-10), the Canine Postamputation Pain (CAMPPAIN) scale. Univariable logistic regression related each dog's calculated score to the probability of PAP.

RESULTS

Multivariable logistic regression identified four independent predictors of PAP (p < 0.05): 1) restlessness or difficulty sleeping, 2) episodes of panic or anxiety, 3) sudden vocalization, and 4) compulsive grooming of the residual limb. Score AUROC was 0.70 (95% confidence interval = 0.63-0.78) with good calibration (Hosmer-Lemeshow statistic p = 0.82). A score of 2 corresponded to a risk probability of 0.5. Taking a score ≥ 2 to indicate PAP, score specificity and sensitivity were 92.1% and 36.4%, respectively. When this score was used to diagnose PAP, prevalence was 36.4% (24/66) and 7.9% (11/139) in the amputation and TPLO groups, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Postamputation pain is characterized by specific postoperative behaviors and appears to affect approximately one-third of canine amputees. The CAMPPAIN scale generated from these data could facilitate diagnosis, treatment and further study of PAP but requires external validation.

摘要

目的

开发一种用于诊断和评估犬截肢后疼痛（PAP）严重程度的量表。

研究设计

单中心回顾性研究。

动物

一家兽医教学医院共 66 只接受了胸或后肢截肢，139 只接受了胫骨平台平整术（TPLO）的狗。

方法

向主人发送了一份关于术后行为变化的在线调查。分类，多项选择答案被输入单变量逻辑回归模型，并使用 Wald 检验测试与截肢的关联。如果 p < 0.2，则将变量转发到用于手动构建的多变量逻辑回归模型。使用接收器操作曲线（AUROC）特征优化模型的简单性和预测能力，并使用 Hosmer-Lemeshow 检验评估模型校准。选择的模型转换为整数量表（0-10），即犬截肢后疼痛（CAMPPAIN）量表。单变量逻辑回归将每只狗的计算得分与 PAP 的概率相关联。

结果

多变量逻辑回归确定了 PAP 的四个独立预测因子（p < 0.05）：1）不安或难以入睡，2）惊恐或焦虑发作，3）突然发声，4）残肢强迫梳理。分数 AUROC 为 0.70（95%置信区间= 0.63-0.78），校准良好（Hosmer-Lemeshow 统计量 p = 0.82）。分数 2 对应于 0.5 的风险概率。将分数≥2 表示为 PAP，得分特异性和敏感性分别为 92.1%和 36.4%。当使用此分数诊断 PAP 时，在截肢和 TPLO 组中，患病率分别为 36.4%（24/66）和 7.9%（11/139）。