Clusters of pain trajectories among patients with sickle cell disease hospitalized for vaso‐occlusive crisis: A data‐driven approach

Abstract

Background Vaso‐occlusive crises (VOCs) are the hallmark of sickle cell disease (SCD), with higher severity among hospitalized patients. Clustering hospitalizations with similar pain trajectories could identify vulnerable patient subgroups. Aims were to (a) identify clusters of hospitalizations based on pain trajectories; (b) identify factors associated with these clusters; and (c) determine the association between these clusters and 30‐day readmissions. Methods We retrospectively included 350 VOC hospitalizations from 2013 to 2016 among 59 patients. Finite mixture modeling identified clusters of hospitalizations from intercepts and slopes of pain trajectories during the hospitalization. Generalized estimating equations for multinomial and logistic models were used to identify factors associated with clusters of hospitalizations and 30‐day readmissions, respectively, while accounting for multiple hospitalizations per patient. Results Three clusters of hospitalizations based on pain trajectories were identified: slow (n = 99), moderate (n = 207), and rapid (n = 44) decrease in pain scores. In multivariable analysis, SCD complications, female gender, and affective disorders were associated with clusters with slow or moderate decrease in pain scores (compared to rapid decrease). Although univariate analysis found that the cluster with moderate decrease in pain scores was associated with lower odds of 30‐day readmissions compared to the cluster with slow decrease, it was nonsignificant in multivariable analysis. SCD complications were associated with higher odds of 30‐day readmissions and older age was associated with lower odds of 30‐day readmissions. Conclusions Our results highlight variability in pain trajectories among patients with SCD experiencing VOC and provide a novel approach for identifying subgroups of patients that could benefit from more intensive follow‐up.

Pain trajectories and well‐being in children and young people with cerebral palsy: A cohort study

“…By characterizing short‐term pain trajectories in children with CP, future studies may focus on identifying factors that have an impact on or improve pain trajectories. Studies of pain trajectories in other paediatric chronic conditions, such as rheumatoid arthritis and sickle cell anaemia, reported similar results 33,34 . Children with juvenile rheumatoid arthritis also grouped into concerning pain trajectories, with chronically moderate and increasing or decreasing pain trajectories; however, these were measured every 6 months for 5 years 33 .…”

“…Studies of pain trajectories in other paediatric chronic conditions, such as rheumatoid arthritis and sickle cell anaemia, reported similar results. 33 , 34 Children with juvenile rheumatoid arthritis also grouped into concerning pain trajectories, with chronically moderate and increasing or decreasing pain trajectories; however, these were measured every 6 months for 5 years. 33 Children hospitalized for sickle cell vaso‐occlusive crises experienced slow, moderate, and rapidly decreasing pain trajectories over 1 week.…”

“… 33 Children hospitalized for sickle cell vaso‐occlusive crises experienced slow, moderate, and rapidly decreasing pain trajectories over 1 week. 34 …”

“…33 Children hospitalized for sickle cell vaso-occlusive crises experienced slow, moderate, and rapidly decreasing pain trajectories over 1 week. 34 The pain intensity trajectory model presented in this study is not based on an inception cohort. Instead, it provides a 5-week snapshot of pain trajectories and serves as a starting point for future work.…”

Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease

“…These results are consistent with a previous report examining acute pain trajectories in SCD, which indicated that hospitalizations among female patients or among those with more frequent complications of SCD were associated with a slower decline in pain intensity. 25 However, in retrospective studies, including this study, acute pain trajectories were examined after presentation to the ED, and the effect of duration of pain experienced at home prior to presentation to the ED on observed pain trajectories in an acute care setting could not be assessed. In addition, although we could not definitely assess for history of chronic pain in this retrospective study, it is likely that some individuals with high HCU also had chronic pain, and the impact of history of chronic pain on pain trajectories could not be assessed.…”