Epidemiology of Upper Limb Complex Regional Pain Syndrome in a Retrospective Cohort of Persons Aged 9-30 Years, 2002-2017.

Autor: Naleway AL; Kaiser Permanente Center for Health Research, Portland, OR, USA., Henninger ML; Kaiser Permanente Center for Health Research, Portland, OR, USA., Irving SA; Kaiser Permanente Center for Health Research, Portland, OR, USA., Bianca Salas S; Kaiser Permanente Center for Health Research, Portland, OR, USA., Kauffman TL; Kaiser Permanente Center for Health Research, Portland, OR, USA., Crane B; Kaiser Permanente Center for Health Research, Portland, OR, USA., Mittendorf KF; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA., Harsh S; Kaiser Permanente Center for Health Research, Portland, OR, USA., Elder C; Kaiser Permanente Center for Health Research, Portland, OR, USA., Gee J; Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Jazyk: angličtina
Zdroj: The Permanente journal [Perm J] 2023 Jun 15; Vol. 27 (2), pp. 75-86. Date of Electronic Publication: 2023 May 08.
DOI: 10.7812/TPP/22.170
Abstrakt: Introduction This paper describes the epidemiology and clinical presentation of complex regional pain syndrome (CRPS) in a large, integrated health care delivery system; and CRPS incidence rates (IRs) over a time period spanning human papillomavirus (HPV) vaccine licensure and published case reports of CRPS following HPV vaccination. Methods The authors examined CRPS diagnoses in patients aged 9-30 years between January 2002 and December 2017 using electronic medical records, excluding patients with lower limb diagnoses only. Medical record abstraction and adjudication were conducted to verify diagnoses and describe clinical characteristics. CRPS IRs were calculated for 3 periods: Period 1 (2002-2006: before HPV vaccine licensure), Period 2 (2007-2012: after licensure but before published case reports), and Period 3 (2013-2017: after published case reports). Results A total of 231 individuals received an upper limb or unspecified CRPS diagnosis code during the study period; 113 cases were verified through abstraction and adjudication. Most verified cases (73%) were associated with a clear precipitating event (eg, non-vaccine-related injury, surgical procedure). The authors identified only 1 case in which a practitioner attributed CRPS onset to HPV vaccination. Twenty-five incident cases occurred in Period 1 (IR = 4.35/100,000 person-years (PY), 95% confidence interval (CI) = 2.94-6.44), 42 in Period 2 (IR = 5.94/100,000 PY, 95% CI = 4.39-8.04), and 29 in Period 3 (IR = 4.53/100,000 PY, 95% CI = 3.15-6.52); differences between periods were not statistically significant. Conclusion These data provide a comprehensive assessment of the epidemiology and characteristics of CRPS in children and young adults and provide further reassurance about the safety of HPV vaccination.
Competing Interests: Conflicts of InterestDr Naleway reports receiving research funding from Pfizer and Vir Biotechnology for unrelated studies. Dr Mittendorf reports support from institutional funding from GE Healthcare. The other authors have no conflicts of interest.
Databáze: MEDLINE
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