Pain Assessment in <scp>INT</scp>ensive care (<scp>PAINT</scp>): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Kemp, Harriet; Bantel, Carsten; Gordon, Fabiana; Brett, Stephen; Laycock, Helen

doi:10.1111/anae.13786

Cited by 36 publications

(35 citation statements)

References 21 publications

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“…As a follow‐up of this study, we plan to evaluate the reliability of the Nasal Photoplethysmography Index during general anaesthesia. However, it might also be useful in critical care because pain assessment is difficult and infrequent . Third, patients who were not analysed due to noise might have affected the results.…”

Section: Discussionmentioning

confidence: 99%

Development of a new analgesic index using nasal photoplethysmography

et al. 2018

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Although surrogate measures to quantify pain intensity have been commercialised, there is a need to develop a new index with improved accuracy. The aim of this study was to develop a new analgesic index using nasal photoplethysmography data. The specially designed sensor was placed between the columella and the nasal septum to acquire nasal photoplethysmography in surgical patients. Nasal photoplethysmography and Surgical Pleth Index (GE Healthcare) data were obtained for 14 min both in the absence (pre-operatively) or presence (postoperatively) of pain in a group of surgical patients, each patient acting as their own control. Various dynamic photoplethysmography variables were extracted to quantify pain intensity; the most accurate index was selected using logistic regression as a classifier. The area under the curve of the receiver-operating characteristic curve was measured to evaluate the accuracy of final model predictions. In total, 12,012 heart beats from 89 patients were used to develop a new Nasal Photoplethysmography Index for analgesic depth quantification. The two-variable model (a combination of diastolic peak point variation and heart beat interval variation) was most accurate in discriminating between the presence and absence of pain (numerical rating scale (NRS) ≥ 3). The accuracy and area under the curve of the receiver-operating characteristic curve for the Nasal Photoplethysmography Index were 75.3% and 0.8018, respectively, and 64.8% and 0.7034, respectively, for the Surgical Pleth Index. The Nasal Photoplethysmography Index clearly distinguished pain (NRS ≥ 3) in awake surgical patients with postoperative pain. The Nasal Photoplethysmography Index performed better than the Surgical Pleth Index. Further validation studies are needed to evaluate its feasibility to quantify pain intensity during general anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Development of a new analgesic index using nasal photoplethysmography

et al. 2018

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“…Expansion of acute pain service‐ roles may facilitate improvements in care in other specialist areas. For example, there is evidence that pain is not well assessed and managed in critically‐ill patients . Delivery of support and education in the critical care setting is facilitated when the acute pain services are involved in related roles such as outreach or resuscitation.…”

Section: Discussionmentioning

confidence: 99%

A survey of acute pain services in the UK

et al. 2017

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The organisational state of inpatient pain management in UK hospitals is difficult to determine. We sent an electronic questionnaire to 209 acute pain service leads throughout the UK. Questions were about staffing and service provision. We received 141 responses (67%); 47% of all UK hospitals. Each service was responsible for a median (IQR [range]) of 566 (400-839 [120-2800]) beds. Each acute pain specialist nurse was responsible for 299 (238-534 [70-1923]) beds. The mean (SD) number of consultant hours per week was 5.54 (4.62), delivered by a median of 1.0 (1.0-2.5 [0.2-7.0]) consultant. Overnight cover was provided by 20 (15%) acute pain services, and weekend cover by 39 (29%). Acute pain services commonly (in 50 (35%) hospitals) had roles in addition to acute pain management. Most teams (105, (77%)) reviewed medical patients and patients with chronic pain (in 131, (96%) teams). Half of the services (56, (49%)), reported that they were part of an integrated acute and chronic pain service, however, 83 (59%) did not have any members who work in chronic pain clinics. The majority (79, (70%)) were able to access a nominated chronic pain consultant for advice. Provision of acute pain services throughout the UK is highly variable. The majority do not meet core UK standards.

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“…Pain was documented as severe in over half of these. Pain assessment was not recorded in a third of cases, which is inadequate, but in keeping with previous research showing that inpatient pain is both poorly assessed and managed [22]. Acute pain is typically nociceptive, but acute neuropathic pain may also occur following damage to peripheral nerves [23,24].…”

Section: Pain and Managementmentioning

confidence: 82%

The incidence of chronic pain following tibial diaphyseal fracture.

Prinsloo¹,

Flynn²,

Prime³

et al. 2019

J Trauma Crit Care

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Patients presenting to a London Major Trauma Centre between 01/01/2016-31/12/2016 with fractures of the tibial diaphysis were retrospectively identified using 'eTrauma' (OpenMedical, London, UK), a digital trauma management system. Cases were validated against the hospitals Electronic Health Record (Cerner Corporation, North Kansas City, USA) and submissions to the Trauma Audit and Research Network (TARN) database. Data collection was done at St Mary's hospital 01/04/2017-30/06/2017. Patient demographic information, injury mechanism, fracture morphology, pain Introduction: Chronic pain affects up to 40% of patients at 7 years after tibial fracture impacting on their quality of life (QoL) and ability to participate in activities of daily living. Major nerves run in close proximity to the tibia and are prone to injury during tibial fracture. Nerve injury can cause acute neuropathic pain, which responds poorly to commonly prescribed analgesics and predisposes patients to developing chronic pain. This study aims to describe the incidence and impact of pain at 6-12 months after tibial fractures. Methods: Patients admitted to a major trauma centre between 01/01/2016-31/12/2016 with isolated tibial fractures were identified using prospectively recorded database eTrauma. Injuries were categorized using the AO classification. Pain and Quality of Life at 6-12 months post injury were assessed using the EuroQol (EQ-5D-5L) questionnaire and the Douleur Neuropathique 4 questionnaire for neuropathic pain. Results: Forty isolated tibial fractures were identified and 20 were followed up. Pain was reported by 18 (90%) of patients. Ten (50%) reported moderate to severe pain, with median pain scores of 2.6/5. Pain scores were significantly greater following high-energy injuries however no significant links were seen between pain and other patient, injury or management factors. Conclusion: Chronic pain is common following tibial fracture and is largely under-reported. Further prospective multi-center investigation is warranted to better identify those with neuropathic pain and other risk factors for chronic pain. This could guide effective management and improve patient outcomes

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Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Cited by 36 publications

References 21 publications

Development of a new analgesic index using nasal photoplethysmography

Development of a new analgesic index using nasal photoplethysmography

A survey of acute pain services in the UK

The incidence of chronic pain following tibial diaphyseal fracture.

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