P. Farley1, R. L. Griffin2, J. O. Jansen3, P. L. Bosarge3 1University Of Alabama at Birmingham,Emergency Medicine,Birmingham, Alabama, USA 2University Of Alabama at Birmingham,Epidemiology,Birmingham, Alabama, USA 3University Of Alabama at Birmingham,Acute Care Surgery,Birmingham, Alabama, USA
Introduction:
Rib fractures are a major problem characterized by pain, which is poorly understood. Measuring total pain experience, taking into account the duration as well as intensity, could facilitate comparisons of different treatments. The aim of this study was to evaluate the feasibility of quantifying pain reported over the course of an admission and to identify factors associated with more pain in patients with rib fractures.
Methods:
Patients admitted to a Level-I academic trauma center with rib fracture or flail chest between 2015 and 2017 were included. For each patient, the maximum pain score (verbal or non-verbal) was calculated for each hospital day. Total pain reported was defined as the sum of the area under the curve (AUC) of the max pain scores plotted against time. The AUC was calculated based on the trapezoidal rule. A general linear model was used to determine demographic, injury, and clinical predictors of the pain AUC. In a post-hoc analysis, models were stratified by Injury Severity Score categories (i.e., 1-8, 9-14, 16-75) to determine whether predictors differed by injury severity.
Results:
We identified 3,713 patients. Increased pain experience was observed for those aged 40-59 years compared to those 18-39 years (B=6.1, p=0.002); ISS 9-14 (b=11.5, p<0.001) and ≥16 (B36.9, p<0.0001) compared to ISS 1-8; patients with flail chest compared to those with multiple rib fractures (B=17.1, p<0.001); and patients who underwent rib fixation (B=20.7, p=0.004). Decreased pain experience was observed for male gender (B=-3.7, p=0.032) and blunt mechanism of injury (B=-13.7, p<0.0001). Associations were broadly similar when the analysis was stratified by overall injury severity, though blunt mechanism was not associated with pain among ISS 1-8 and age ≥60 was associated with decreased pain among those with ISS 16-75 (B=-7.4, p=0.026).
Conclusion:
This study demonstrates the feasibility and usefulness of measuring patients’ total pain experience over the duration of their admission. As reported, pain—a product of pain and analgesia—is a subjective but highly relevant measure of patients’ experience. Our study identifies a number of predictive factors, some expected (such as overall injury severity, reflecting additional injuries) and some unexpected. Increased overall pain experience following fixation may be the result of severe pain prior to intervention. We are planning further work to advance the concept of total reported pain experience.
