High Outpatient Pain Intensity Scores Predict Impending Hospital Admissions in Patients with Cancer

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.