Predictors of treatment failure pain among patients gunshot wounds

Background: In patients with gunshot wounds during hostilities in Ukraine, 70% have negative results of pain treatment, which leads to its chronicity. Identifying predictors of negative pain treatment outcomes in these patients could potentially improve their treatment outcomes. Methods: : The treatment of 1555 patients was analyzed. The results of the treatment were assessed using the visual analog scale (VAS). Comparison of groups was carried out according to the Mann-Whitney test. The method of constructing univariate and multivariate logistic regression models was used to analyze the relationship between the risks of receiving a negative treatment result and factor characteristics. The quality of the models was assessed by the area under the ROC curve (AUC – Area under the ROC curve). To quantify the degree of influence of the factor characteristic, the odds ratio indicator was calculated. Results: : Predictors of negative results of pain treatment in patients with gunshot wounds are: 1) method of pain treatment (p<0.001), OR=0.10 (95% CI 0.08–0.13); 2) type of anesthesia: the risk of receiving negative treatment results is higher when using general anesthesia compared to regional (p<0.001), OR =0.59 (0.44-0.78) and regional with sedation (p<0.001), OR =0.44 (0.33-0.57) ; 3) the number of injured anatomical parts of the body (p<0.001), OR =0.82 (0.75-0.90); 4) the number of performed operations (p=0.036) OR =0.94 (0.90-0.99); 5) high intensity of pain according to VAS at admission (p<0.001), OR=1.60 (95% CI 1.39-1.84). Conclusions: : The analysis showed that the method of pain treatment, the use of general anesthesia compared to regional anesthesia (regardless of the use of sedation), the number of injured anatomical parts of the body, the number of surgical interventions performed on the patient and the high intensity of pain upon admission to the medical institution are associated with a greater risk of receiving negative treatment results pain in patients with gunshot wounds. Giving preference to the use of a combination of pain treatment methods with regional anesthesia methods, pain control at the stage of transportation to a medical institution can potentially improve the results of treatment of such patients. Trial registration ClinicalTrials.gov: Retrospectively registered on July 29, 2022, NCT05482061.