High Outpatient Pain Intensity Scores Predict Impending Hospital Admissions in Patients with Cancer
Accepted 13 July 2009. published online 21 December 2009.
Abstract
Context
Pain intensity scores (PIS) are frequently collected in the outpatient setting. The implications for patients with high PIS have not been well-studied.
Objectives
This retrospective review was designed to determine whether high outpatient encounter PIS identify patients at risk of hospital admission.
Methods
Numerical PIS (0–10) were collected from all outpatient medical and radiation oncology encounters at the Johns Hopkins Comprehensive Cancer Center from 2004 to 2006. These were merged with an inpatient database to identify admissions occurring within 30 days of the outpatient encounter. PIS were categorized as 0–3 (mild), 4–6 (moderate), and 7–10 (severe). Odds ratios for hospital admission were calculated using generalized estimating equations.
Results
Of 119,069 encounters, 116,713 (98%) were evaluable, and 5,089 encounters (4.5%) had PIS of 7–10. Twenty-nine percent of these high PIS encounters had hospital admissions within 30 days. Encounters with PIS of 7–10 and 4–6 were 96% and 43%, respectively, more likely to result in hospital admission within 30 days compared with encounters with PIS<4 (P<0.001). Hospital admission rates after encounters with PIS of 7–10 were highest in patients with melanoma (58%), sarcoma (42%), female genital cancer (39%), and upper aerodigestive (36%) cancer.
Conclusion
Outpatients with cancer and high PIS are at increased risk of hospital admission within 30 days. This high-risk group should be targeted for early supportive care interventions aimed at reducing hospitalizations and improving quality of life.
aDepartment of Internal Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
cDepartment of Medical Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland, USA
Address correspondence to: Nina D. Wagner-Johnston, MD, Washington University School of Medicine, 660 South Euclid, Box 8056, St. Louis, MO 63110, USA.
This study was accepted as an abstract for publication at the 44th Annual American Society of Clinical Oncology (ASCO) Meeting in May 2008 and at the 4th Annual Chicago Supportive Oncology Conference in October 2008.
Kathryn A. Carson's work on this manuscript was supported by Grant Number UL1 RR 025005 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research.
ABSTRACT