A Clinical Tool to Predict Severe Pain During Wound Dressing Changes

Introduction: Dressing changes cause severe pain (i.e., 8 to 10 on a 10-poiont scale) for approximately one-third (36%) of patients with open skin wounds. No tool exists that allows nurses to predict which patients are likely to experience severe pain during dressing changes.

Objective: The aim of the study was to develop a clinical tool to predict severe pain during dressing changes using clinically accessible wound and pain predictors and to evaluate the diagnostic validity of this model.

Methods: Using a cross-sectional design, a one-time study dressing change was conducted by the same wound care nurse on 445 subjects while concurrently measuring patient and wound predictors and pain intensity during the dressing change. Results: Among 445 subjects who completed study procedures, 48.3% were male, 94.4% were White, and 50.5% were younger than 60. Acute wound was the most frequent (86.5%) wound type among all subjects. Severe wound pain during the dressing change was reported by 127 (29%) subjects. Three predictors came out of the study as most useful for a clinical prediction tool: type of dressing, resting wound pain and expected pain. Algorithms based on these predictors are presented that can be applied in other settings to predict patients likely to experience severe pain during a dressing change.

Discussion: This is the first study to systematically examine a comprehensive set of wound and patient predictors for their individual and collective associations with pain during dressing changes using precisely defined and rigorously measured study variables. The ability to predict which patients are likely to have severe pain during dressing changes is critically needed so they can be targeted for preventive pain control strategies.