Long-term disability after blunt chest trauma: Don’t miss chronic neuropathic pain!

doi:10.1016/j.injury.2018.10.023

Injury

Volume 50, Issue 1, January 2019, Pages 113-118

https://doi.org/10.1016/j.injury.2018.10.023 Get rights and content

Highlights

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Chronic pain and long-term respiratory disability are very common after severe blunt chest trauma patients.
•
Neuropathic pain is frequently under-diagnosed and responsible for significant impairment of quality of life.
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A thoracic trauma severity score ≥12 is associated with the occurrence of neuropathic pain at 3 months.

Abstract

Introduction The main objective of this prospective study was to assess the incidence of chronic pain and long-term respiratory disability in a single-center cohort of severe blunt chest trauma patients.

Methods Over a 10-month period, all consecutive blunt chest trauma patients admitted in Intensive Care Unit (ICU) were screened to participate in a 3-month and 12-month follow-up. The following variables were prospectively assessed: persistence of chronic chest pain requiring regular used of analgesics, neuropathic pain, respiratory disability, physical and mental health status. Univariate and multivariable analysis were conducted to assess variables associated with chronic chest pain, neuropathic chest pain and respiratory disability.

Results During the study period, 65 patients were included in the study. Chronic chest pain and respiratory disability were reported in 62% and 57% of patients respectively at 3 months postinjury. Neuropathic pain was reported in 22% of patients, associated with higher impairment of quality of life. A thoracic trauma severity score ≥12 and a pain score ≥4 at SICU discharge were the only variables significantly associated with the occurrence of neuropathic pain at 3 months (OR = 7 [2–32], p = 0.01 and OR = 16 [4–70], p < 0.0001).

Conclusion According to the current study, chronic pain and long-term respiratory disability are very common after severe blunt chest trauma patients. Special attention should be paid to neuropathic pain, frequently under-diagnosed and responsible for significant impairment of quality of life.

Introduction

Blunt chest trauma remains an issue in the acute care settings, potentially leading to secondary respiratory complications depending on the severity of injuries and the patient’s conditions [1]. In this context, implementation of clinical pathways and multidisciplinary interventions may reduce the rate of secondary respiratory complications and improve patient outcomes [[2], [3], [4], [5], [6]]. On the other hand, little is known about the long-term outcome of such multimodal strategies [[7], [8], [9]]. Historical cohort studies have reported up to 50% of chronic pain and long term disability after blunt chest trauma, associated with a significant impairment of quality of life [10,11].

Prevention of chronic pain is of paramount importance as it remains a leading cause of work loss, high utilization of health-care resources, major depression and analgesic misuse [12]. Although the intensity of acute pain has been associated with chronic pain, very few cohort studies described the initial analgesia and ventilation strategies during the acute care settings [11,12]. We thus hypothesized that a better control of analgesia in the acute care settings could improve the long-term disability. Furthermore, the characteristics of chronic pain remain poorly documented, whereas the neuropathic component could benefit from a specific treatment [13,14]. The main objective of this prospective study was thus to assess the incidence of chronic pain and long-term respiratory disability in a single-center cohort of severe blunt chest trauma patients. The secondary objective was to determine predictive factors associated with chronic pain or long-term respiratory disability.

Section snippets

Population and settings

Over a 10-month period (June 2016 to March 2017), all consecutive patients admitted in our Surgical Intensive Care Unit (SICU) for a blunt chest trauma with more than 3 rib fractures were considered to participate in a 3-month and 12-month follow-up. During this period, every patient was managed according to a bundle of care developed from the up-to-date French guidelines (Table 1).

For all eligible patients, an intensivist-led follow-up visit was scheduled 3 months after ICU admission

Population

During the study period, 96 consecutive patients were admitted for a severe blunt chest trauma. Thirty-one patients were not included for the 3-month follow-up (24 refusing to participate, 4 ≥ 80 years old and 3 deaths). Finally, 65 patients were included in the study. Their main characteristics are shown in Table 2. Among these patients, only one died before the 12-month follow-up phone call. Among the 43 preinjury working patients, only 4 (9%) had returned to work at 3 months and 26 (60%) at

Discussion

The main objective of this study was to assess the incidence of chronic pain in a single-center cohort of severe blunt chest trauma patients managed by a multidisciplinary bundle of care [5]. Despite a strict control of analgesia in the acute care settings, the incidence of chronic chest pain remained high, respectively reported in 62% at 3 months and 30% at 12 months postinjury. The long-term disabilities were responsible for alterations of quality of life and loss of productivity, 40% of

Conclusion

According to the current study, chronic pain and long-term respiratory disability are very common after severe blunt chest trauma patients. Only a specific follow-up can detect long-term complications and provide a specialized management in order to improve the long-term outcome and quality of life.

Summary conflict of interest statements

No conflicts exist for the current study. Only departmental funds were used for this study. No external funds were obtained.

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Long-term disability after blunt chest trauma: Don’t miss chronic neuropathic pain!

Highlights

Abstract

Introduction

Section snippets

Population and settings

Population

Discussion

Conclusion

Summary conflict of interest statements

Anaesth Crit Care Pain Med

Surgery

J Am Coll Surg

Anaesth Crit Care Pain Med

Am J Surg

Injury

Am J Surg

Med Clin North Am

Injury

J Pain

J Clin Epidemiol

Pain

Anaesth Crit Care Pain Med

Am J Surg