目的:建立诊断和评估犬截肢后疼痛(PAP)严重程度的量表。
方法:单中心回顾性研究。
方法:在兽医教学医院共66只接受胸或骨盆截肢的狗和139只接受胫骨平台整平截骨术(TPLO)的狗。
方法:将一项关于术后行为变化的在线调查发送给患者。分类,将多项选择反应输入单变量逻辑回归模型,并使用Wald检验检验与截肢的相关性.如果p<0.2,则将变量转发到多变量逻辑回归模型以进行手动构建。使用接收器工作曲线下面积(AUROC)特征优化模型的简单性和预测能力,模型校准使用Hosmer-Lemeshow检验进行评估。将所选模型转换为整数标度(0-10),犬截肢后疼痛(CAMPPAIN)量表。单变量逻辑回归将每只狗的计算得分与PAP的概率相关。
结果:多变量逻辑回归确定了PAP的四个独立预测因子(p<0.05):1)躁动或睡眠困难,2)恐慌或焦虑的发作,3)突然发声,和4)强迫性修饰残肢。AUROC评分为0.70(95%置信区间=0.63-0.78),校准良好(Hosmer-Lemeshow统计p=0.82)。2分对应于0.5的风险概率。得分≥2表示PAP,评分特异性和敏感性分别为92.1%和36.4%,分别。当这个分数被用来诊断PAP时,截肢组和TPLO组的患病率分别为36.4%(24/66)和7.9%(11/139),分别。
结论:截肢后疼痛的特征是特定的术后行为,并且似乎影响约三分之一的犬截肢者。从这些数据生成的CAMPPAIN量表可以促进诊断,PAP的治疗和进一步研究,但需要外部验证。
OBJECTIVE: To develop a scale to diagnose and assess the severity of postamputation pain (PAP) in dogs.
METHODS: Single-center retrospective study.
METHODS: A total of 66 dogs that underwent thoracic or pelvic limb amputation and 139 dogs that underwent tibial plateau leveling osteotomy (TPLO) at a veterinary teaching hospital.
METHODS: An online survey regarding postoperative behavioral changes was sent to owners. Categorical, multiple-choice responses were entered into a univariable logistic regression model and tested for association with amputation using the Wald test. If p < 0.2, variables were forwarded to a multivariable logistic regression model for manual build. Model simplicity and predictive ability were optimized using the area under the receiver operating curve (AUROC) characteristic, and model calibration was assessed using the Hosmer-Lemeshow test. The selected model was converted to an integer scale (0-10), the Canine Postamputation Pain (CAMPPAIN) scale. Univariable logistic regression related each dog\'s calculated score to the probability of PAP.
RESULTS: Multivariable logistic regression identified four independent predictors of PAP (p < 0.05): 1) restlessness or difficulty sleeping, 2) episodes of panic or anxiety, 3) sudden vocalization, and 4) compulsive grooming of the residual limb. Score AUROC was 0.70 (95% confidence interval = 0.63-0.78) with good calibration (Hosmer-Lemeshow statistic p = 0.82). A score of 2 corresponded to a risk probability of 0.5. Taking a score ≥ 2 to indicate PAP, score specificity and sensitivity were 92.1% and 36.4%, respectively. When this score was used to diagnose PAP, prevalence was 36.4% (24/66) and 7.9% (11/139) in the amputation and TPLO groups, respectively.
CONCLUSIONS: Postamputation pain is characterized by specific postoperative behaviors and appears to affect approximately one-third of canine amputees. The CAMPPAIN scale generated from these data could facilitate diagnosis, treatment and further study of PAP but requires external validation.