A cross-sectional study of predictors of pain control during the transition from the surgical intensive care unit to surgical ward

Abstract

Background: The transition of patients from the intensive care unit (ICU) to the ward is a complicated process and patients may be at risk of increased levels of pain.

Objectives: The primary objective was to identify predictors of pain during the transition from the surgical ICU to the surgical ward. The secondary objective was to describe the patient pain experience during this transition.

Methods: This was a cross-sectional study conducted at an academic medical centre in the United States. Patients who were discharged from the ICU were interviewed regarding their pain during transition from ICU to the ward using the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R). The primary outcome measures were the total score of this validated instrument (0-180 points) and score of the pain severity and sleep interference subscale (0-50 points). Predictors of pain control during this 24-h transition period were identified using linear regression analysis.

Results: A total of 50 patients were included. After transition from the ICU, the median score on the APS-POQ-R was 45 (Q1 29 to Q3 74), and the median score on the pain severity and sleep interference subscale was 23 (Q1 15 to Q3 30). After adjusting for sex in a multivariate model, mean pain score in the preceding 24 h of ICU stay explained 31% of the variation in total APS-POQ-R score and 39% of variation in the pain severity and sleep interference subscale. Age, sex, race, type of surgery, number of surgeries, and opioid dose in the 24-h period before transfer were not significantly associated with either outcome measure. The worst pain experienced by patients during transfer was severe (i.e. score ≥7 on 0 to 10 scale) in 90% (n = 45) of patients. For 70% (n = 35) of patients, severe pain persisted for more than 50% of the time during the transition period.

Conclusion: Pain scores in the last 24 h of ICU stay is a predictor of total APS-POQ-R score and pain severity and sleep interference subscale score.

Keywords: Analgesia; Critical care; Intensive care; Pain.