Electronic Continuous Pain Measurement vs Verbal Rating Scale in gynaecology: A prospective cohort study

Background. Several predictors have been shown to be independently associated with chronic postsurgical pain for gastrointestinal surgery, but few studies have investigated the factors associated with acute postsurgical pain (APSP). The aim of this study was to identify the predictors of APSP intensity and severity through investigating demographic, psychological, and clinical variables. Methods. We performed a prospective cohort study of 282 patients undergoing gastrointestinal surgery to analyze the predictors of APSP. Psychological questionnaires were assessed 1 day before surgery. Meanwhile, demographic characteristics and perioperative data were collected. The primary outcomes are APSP intensity assessed by numeric rating scale (NRS) and APSP severity defined as a clinically meaningful pain when NRS ≥4. The predictors for APSP intensity and severity were determined using multiple linear regression and multivariate logistic regression, respectively. Results. 112 patients (39.7%) reported a clinically meaningful pain during the first 24 hours postoperatively. Oral morphine milligram equivalent (MME) consumption (β 0.05, 95% CI 0.03–0.07, p < 0.001 ), preoperative anxiety (β 0.12, 95% CI 0.08–0.15, p < 0.001 ), and expected postsurgical pain intensity (β 0.12, 95% CI 0.06–0.18, p < 0.001 ) were positively associated with APSP intensity. Furthermore, MME consumption (OR 1.15, 95% CI 1.10–1.21, p < 0.001 ), preoperative anxiety (OR 1.33, 95% CI 1.21–1.46, p < 0.001 ), and expected postsurgical pain intensity (OR 1.36, 95% CI 1.17–1.57, p < 0.001 ) were independently associated with APSP severity. Conclusion. These results suggested that the predictors for APSP intensity following gastrointestinal surgery included analgesic consumption, preoperative anxiety, and expected postsurgical pain, which were also the risk factors for APSP severity.

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A prospective cohort study on predictors of mortality of delirium in an emergency observational unit

QJM ◽

10.1093/qjmed/hcaa183 ◽

2020 ◽

Author(s):

S Pal ◽

N Sharma ◽

S M Singh ◽

S Kumar ◽

A K Pannu

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Rating Scale ◽

Confusion Assessment Method ◽

Assessment Method ◽

Rapid Screening ◽

Confusion Assessment

Summary Background Delirium is often an underdiagnosed and underestimated neuropsychiatric syndrome, especially in low- and middle-income countries. Aim To document the prevalence and clinical profile of delirium and to detect the baseline parameters associated with in-hospital mortality. Design A prospective cohort study conducted between January 2016 to December 2016 at an adult medical emergency observational unit of an academic hospital in north India. Methods Confusion Assessment Method for the intensive care unit was used for screening and diagnosis of delirium. Subtypes of delirium and severity were defined with the Richmond agitation-sedation scale and Delirium Rating Scale-Revised-98 (DRS-R-98). Results Out of 939 screened patients, 312 (33.2%) had delirium, including 73.7% unrecognized cases. The mean age was 49.1 ± 17.3 years (range 17–90), and only 33.3% of the patients were above 60 years. The prevalence of hypoactive, mixed and hyperactive delirium was 39.1, 33.7 and 27.2%, respectively. Usual predisposing factors were alcohol use disorder (57.4%) and hypertension (51.0%), and infections remain the most common precipitating factors (42.0%). In total, 96.1% of patients received midazolam before delirium onset, and physical restraints were used in 73.4%. Mortality was higher in delirium (19.9% vs. 6.4%). The independent predictors of death in delirium were low diastolic blood pressure (P-value = 0.000), Glasgow coma scale score <15 (P = 0.026), high Acute Physiology and Chronic Health Evaluation II score (P = 0.007), high DRS-R-98 severity score (P = 0.000) and hyperactive delirium (P = 0.024). Conclusion Rapid screening with Confusion Assessment Method for the intensive care unit detected a high prevalence of delirium (even in young patients), and it associated with high mortality.

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Impact of Comorbidity Burden on Cognitive Decline: A Prospective Cohort Study of Older Adults with Dementia

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000514651 ◽

2021 ◽

pp. 1-8

Author(s):

Sheng-Lun Kao ◽

Jen-Hung Wang ◽

Shu-Cin Chen ◽

Yu-Ying Li ◽

Ya-Lin Yang ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Cognitive Function ◽

Cognitive Decline ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Rating Scale ◽

Severity Index ◽

Moderate Dementia ◽

Comorbidity Burden

Introduction: The lack of longitudinal data of comorbidity burden makes the association between comorbidity and cognitive decline inconclusive. We aimed to measure comorbidity and assess its effects on cognitive decline in mild to moderate dementia. Methods: This was a prospective cohort study. The participants were enrolled from the Hualien Tzu Chi Hospital between January 2015 and December 2018. We enrolled 175 older adults with mild to moderate dementia and conducted in-person interviews to follow-up comorbidity and cognitive function annually. The comorbidity burden indices included Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Charlson Comorbidity Index (CCI), and Medication Regimen Complexity Index (MRCI), and cognitive function was measured by Mini-Mental State Examination (MMSE) and clock drawing test. We employed the generalized estimating equations to assess the longitudinal effect of time-varying comorbidity burden on cognitive decline after adjusting for age, sex, and education. Results: Most patients were diagnosed with Alzheimer’s disease (88.6%) and in the early stage of dementia (Clinical Dementia Rating [CDR] = 0.5, 57.1%; CDR = 1, 36.6%). Multimorbidity was common (median: 3), and the top 3 most common comorbidities were osteoarthritis (67.4%), hypertension (65.7%), and hyperlipidemia (36.6%). The severity index of CIRS-G was significantly associated with cognitive decline in MMSE after adjusting for age, sex, and education. CCI and MRCI scores were, however, not associated with cognitive function. Conclusion: The severity index of CIRS-G outperforms CCI and MRCI in reflecting the longitudinal effect of comorbidity burden on cognitive decline in mild to moderate dementia.

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Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

Anesthesiology ◽

10.1097/aln.0000000000003951 ◽

2021 ◽

Vol 135 (4) ◽

pp. 711-723

Author(s):

James S. Khan ◽

Daniel I. Sessler ◽

Matthew T. V. Chan ◽

C. Y. Wang ◽

Ignacio Garutti ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Rating Scale ◽

Noncardiac Surgery ◽

Persistent Pain ◽

Increased Risk ◽

History Of ◽

Incisional Pain

Background The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain. Methods This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery). Results Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P < 0.001), surgery for fracture (P < 0.001), history of chronic pain (P < 0.001), coronary artery disease (P < 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P < 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P < 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P < 0.001, respectively). Older age (P < 0.001), endoscopic surgery (P = 0.005), and South Asian (P < 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P < 0.001) were associated with a lower risk of persistent pain. Conclusions Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Delirium occurrence in older Irish adults admitted to an acute medical hospital: a prospective cohort study

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.133 ◽

2021 ◽

pp. 1-9

Author(s):

C. Dolan ◽

M. Mohd Zubir ◽

V. Melvin ◽

G. McCarthy ◽

D. Meagher ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Functional Ability ◽

Prospective Cohort ◽

Rating Scale ◽

Physical Illness ◽

Illness Severity ◽

University Hospital ◽

Medical Inpatients ◽

Impaired Cognition

Objectives Delirium, which is associated with adverse health outcomes, is poorly detected in hospital settings. This study aimed to determine delirium occurrence among older medical inpatients and to capture associated risk factors. Methods This prospective cohort study was performed at an Irish University Hospital. Medical inpatients 70 years and over were included. Baseline assessments within 72 hours of admission included delirium status and severity as determined by the Revised Delirium Rating Scale (DRS-R-98), cognition, physical illness severity and physical functioning. Pre-existing cognitive impairment was determined with Short Informant Questionnaire on Cognitive Decline (IQCODE). Serial assessment of delirium status, cognition and the physical illness severity were undertaken every 3 (±1) days during participants’ hospital admission. Results Of 198 study participants, 92 (46.5%) were women and mean age was 80.6 years (s.d. 6.81; range 70–97). Using DRS-R-98, 17.7% (n = 35) had delirium on admission and 11.6% (n = 23) had new-onset delirium during admission. In regression analysis, older age, impaired cognition and lower functional ability at admission were associated with a significant likelihood of delirium. Conclusions In this study, almost one-third of older medical inpatients in an acute hospital had delirium during admission. Findings that increasing age, impaired cognition and lower functional ability at admission were associated with increased delirium risk suggest target groups for enhanced delirium detection and prevention strategies. This may improve clinical outcomes.

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