Risk Factors of Significant Pain Syndrome 90 Days After Minor Thoracic Injury: Trajectory Analysis

• Published in: Academic emergency medicine 2013-11, Vol.20 (11), p.1139-1145
• Main Authors: Daoust, Raoul, Émond, Marcel, Bergeron, Éric, LeSage, Natalie, Camden, Stéphanie, Guimont, Chantal, Vanier, Laurent, Chauny, Jean‐Marc, Bird, Steven B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Injuries; Male; Middle Aged; Multivariate analysis; Pain; Pain - drug therapy; Pain - epidemiology; Pain Measurement; Prevalence; Prospective Studies; Quebec - epidemiology; Rib Fractures - complications; Risk Factors; Syndrome; Thoracic Injuries - complications; Thoracic Injuries - therapy
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.12248

Objectives The objective was to identify the risk factors of clinically significant pain at 90 days in patients with minor thoracic injury (MTI) discharged from the emergency department (ED). Methods A prospective, multicenter, cohort study was conducted in four Canadian EDs from November 2006 to November 2010. All consecutive patients aged 16 years or older with MTI were eligible at discharge from EDs. They underwent standardized clinical and radiologic evaluations at 1 and 2 weeks, followed by standardized telephone interviews at 30 and 90 days. A pain trajectory model characterized groups of patients with different pain evolutions and ascertained specific risk factors in each group through multivariate analysis. Results In this cohort of 1,132 patients, 734 were eligible for study inclusion. The authors identified a pain trajectory that characterized 18.2% of the study population experiencing clinically significant pain (>3 of 10) at 90 days after a MTI. Multivariate modeling found two or more rib fractures, smoking, and initial oxygen saturation below 95% to be predictors of this group of patients. Conclusions To the authors' knowledge, this is the first prospective study of trajectory modeling to detect risk factors associated with significant pain at 90 days after MTI. These factors may help in planning specific treatment strategies and should be validated in another prospective cohort. Resumen Objetivos Identificar los factores de riesgo de dolor clínicamente significativo a los 90 días en los pacientes con traumatismo torácico menor dados de alta desde el servicio de urgencias (SU). Metodología Se llevó a cabo un estudio de cohorte, prospectivo y multicéntrico, en cuatro SU canadienses de noviembre de 2006 hasta noviembre de 2010. Se seleccionó de forma consecutiva todo paciente de 16 años o más con traumatismo torácico menor dado de alta desde el SU. Se llevaron a cabo evaluaciones clínicas y radiológicas en la primera y segunda semanas, seguidas de entrevistas telefónicas estandarizadas a los 30 y 90 días. Un modelo de la trayectoria del dolor caracterizó a los grupos de pacientes con las diferentes evoluciones del dolor y determinó los factores de riesgo específicos en cada grupo a través de un análisis multivariado. Resultados En esta cohorte de 1.132 pacientes, se eligieron 734 para la inclusión en el estudio. Se identificó una trayectoria dolorosa en un 18,2% de la población del estudio que experimentó un dolor clínicamente significativo (3 s