Relationships between outpatient pain scores and acute care utilization in sickle cell disease

Abstract

Severe sickle cell pain often but not always leads to utilization of acute care services. We examined the relationship between pain measured during a routine outpatient clinic visit and acute-care utilization events during their first year of an acute-care study. During a routine outpatient clinic visit, adults with SCD completed PAINReportIt, a computerized comprehensive pain assessment tool that is reliable and has published validity and acceptability in adults with SCD. We created a Composite Pain Index (CPI) by converting pain location, intensity, total pain rating index, and pattern scores to a 0-100 scale and summing scores. All acute-care utilization events (Emergency Department, Acute Care Center, inpatient hospitalization) were documented during the subsequent study year for the 137 study participants who had entered the acute-care study phase at the time of this analysis. Their mean age was 34±11 years (65% women; 95% African American). Mean pain intensity at the clinic visit did not differ by utilization group, but least pain (F(2,134)=3.6, p<.03) and worst pain (F(2,134)=4.0, p<.02) in the past 24 hours, and CPI (F(2,134)=6.1, p<.003) differed significantly by utilization group. Patients who had no acute-care utilization events did not differ from other utilization groups on their current pain, but had significantly lower least and worst pain in the previous 24 hours and CPI scores than the other two utilization groups (1-3, ≥4 events). Patients with ≥4 utilization events had higher pain scores on all measures, but these scores were not significantly different than scores reported by patients with 1-3 utilization events. Differences in CPI scores were more profound than least or worst pain intensity. CPI scores should be examined for potential to predict patients at most risk for acute exacerbations of their SCD pain.