Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
Anesthesia and Operation Center, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
Eur J Pain. 2022 Nov;26(10):2188-2197. doi: 10.1002/ejp.2033. Epub 2022 Sep 17.
An integrated score that globally assesses perioperative pain experience and rationally weights each component has not yet been developed.
A development dataset specific to adult Chinese patients undergoing orthopaedic surgery was obtained from PAIN OUT (1985 qualified patients of 2244). A more recent validation dataset obeying the same conditions was obtained from the Chinese Anaesthesia Shared-database Platform (1004 qualified patients of 1032). Outcomes were assessed using the International Pain Outcomes Questionnaire (IPO-Q), which comprises key patient-level outcomes of perioperative pain management, including pain experience and perceptions of care. Using principal component analysis and regression models, a composite score (CS) was inferred to integrate pain experience. The discrimination of the CS for dissatisfaction and desire for more pain treatment was compared with that of the worst pain score.
A CS was developed from the 12 items of the IPO-Q regarding pain experience. The weight for calculating the CS was worst pain 11, least pain 17, time spent in severe pain 11, interference with activity in bed 9, interference with breathing deeply or coughing 10, interference with sleep 9, anxiety 12, helplessness 12, nausea 0, drowsiness 2, itch 5 and dizziness 2. In external validation, the CS indicated superior discrimination to the worst pain in predicting dissatisfaction (p < 0.001) and desire for more pain treatment (p < 0.001).
This study introduced a methodology to integrate outcomes regarding perioperative pain experience into a CS, which was based on the weight of each item.
This novel methodology sheds additional light on the riveting issue of carefully integrating several measures into a composite endpoint, which may be useful for quality improvement purposes when addressing the impact of a change in clinical practice.
目前尚未开发出一种综合评分系统，能够全面评估围手术期疼痛体验，并合理权衡各个组成部分的权重。
从 PAIN OUT（1985 年 2244 名合格患者中的 1985 名）中获取特定于接受骨科手术的中国成年患者的开发数据集，并从中国麻醉共享数据库平台（符合相同条件的 1032 名合格患者中的 1004 名）中获得更近期的验证数据集。使用国际疼痛结局问卷（IPO-Q）评估结局，该问卷包含围手术期疼痛管理的关键患者结局，包括疼痛体验和对护理的看法。使用主成分分析和回归模型推断综合评分（CS），以整合疼痛体验。CS 对不满意和需要更多疼痛治疗的区分能力与最差疼痛评分进行比较。
从 IPO-Q 中关于疼痛体验的 12 个项目中开发了 CS。计算 CS 的权重为：最差疼痛 11 分，最不疼痛 17 分，处于严重疼痛时间 11 分，卧床活动干扰 9 分，深呼吸或咳嗽干扰 10 分，睡眠干扰 9 分，焦虑 12 分，无助感 12 分，恶心 0 分，嗜睡 2 分，瘙痒 5 分，头晕 2 分。在外部验证中，CS 在预测不满意（p < 0.001）和需要更多疼痛治疗（p < 0.001）方面的区分能力优于最差疼痛评分。
本研究介绍了一种将围手术期疼痛体验相关结局整合到 CS 中的方法，该方法基于每个项目的权重。
这种新方法为将几个措施整合到一个综合终点提供了更多思路，这对于解决临床实践变化的影响时，改善质量的目的可能是有用的。
