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Multicenter Study
. 2024 Dec 19;24(1):460.
doi: 10.1186/s12871-024-02836-8.

Cumulative incidence of chronic pain after visiting a Dutch emergency department with acute pain

S Mol  1 , A V Brown  1   2 , T M Kuijper  3 , M G Bouwhuis  4 , B de Groot  5   6 , A J Out  7 , M G Ibelings  8 , J S H A Koopman  9
Affiliations
Multicenter Study

Cumulative incidence of chronic pain after visiting a Dutch emergency department with acute pain

S Mol et al. BMC Anesthesiol. .

Abstract

Background: Chronic pain is a substantial problem in modern healthcare resulting in health care overutilization. The cumulative incidence of developing chronic pain after visiting the emergency department with acute pain has been determined for specific patient groups only. If the cumulative incidence of chronic pain in emergency department patients with acute pain is high, more proactive measures are justified to limit development of chronic pain. The primary objective was to study the cumulative incidence of chronic pain in patients visiting Dutch emergency departments with acute pain. In addition, we compared the Health-Related Quality of Life (HRQOL) and pain related interference with work.

Methods: In this prospective multicenter cohort study data was collected from adult patients visiting the emergency department with acute pain. Chronic pain was defined by means of a numeric rating scale (NRS) of ≥ 1 measured 90 days after the initial visit. HRQOL was measured with European Quality of Life (EQ-5D-5 L) and Short Form (SF-36) questionnaires.

Results: 1906 patients were included of which 825 had complete data. Of these, 559 patients (67.8%; 95%CI: 64.5 - 70.9%) scored an NRS ≥ 1 after 90 days. Incidence with completed analyses (with imputed data) was similar. Patients with chronic pain reported a significantly lower HRQOL; EQ-5D-5 L index (median 0.82 vs. 1.00) and significantly more pain related hindrance (median 1.00 vs. 0.00).

Conclusions: 67.8% of the responders scored NRS ≥ 1 90 days after ED-visit with acute pain. Regardless of the used definition, chronic pain is associated with a lower HRQOL and more pain related hindrance.

Keywords: Acute pain; Chronic pain; Emergency service; Quality of life.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Medical research ethics committee (METC, Protocol 2018-39) approved the study. Local approval was obtained by all participating centres and was conducted in accordance to the principles of the Declaration of Helsinki. Patients provided written informed consent according to the procedure approved by the METC. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
90-day patient flow
Fig. 2
Fig. 2
Forest plot showing the incidence of chronic pain (pain (NRS ≥ 1) at day 90 in n = 825 patients for each center. The Haaglanden Medical Center location Bronovo and Westeinde are combined in this forest plot and named “HL” (n = 17 inclusions). Error bars indicate 95% Wilson score confidence intervals. Overall incidence is indicated by the vertical dashed line. The null-hypothesis that centers were different with respect to incidence was not rejected (Likelihood ratio test comparing a logistic regression model with centers included as covariates to an intercept only model, P = 0.339). Abbreviations: AM: Amsterdam University Medical Center location AMC, Amsterdam, AS: Albert Schweitzer Hospital, Zwijndrecht, ASD: Albert Schweitzer Hospital location Dordwijk, Dordrecht, CZ: Catharina hospital, Eindhoven, EM: Erasmus Medical Center, Rotterdam, FG: Franciscus Gasthuis, Rotterdam, FV: Franciscus Vlietland, Schiedam, HL: Haaglanden Medical Center location Bronovo and Westeinde, Den Haag, LU: Leiden University Medical Center, Leiden, MZ: Maasstad Hospital, Rotterdam, RG: Reinier de Graaf Hospital, Delft, VU: Amsterdam University Medical Center location VU, Amsterdam, ZL: Zuyderland Medical Center, Heerlen, ZLS: Zuyderland Medical Center, Sittard-Geleen
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