Assessing pain in critically ill brain-injured patients: a psychometric comparison of 3 pain scales and videopupillometry
| Autor: | Océane Garnier, Nicolas Molinari, Christine Bernard, Samir Jaber, Claire Duflos, Kevin Chalard, Pierre-François Perrigault, Valentine Delmas, Gerald Chanques |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Psychometrics Critical Illness Pain Richmond Agitation-Sedation Scale 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Pain assessment Clinical endpoint Medicine Humans Aged Pain Measurement Critically ill business.industry Glasgow Coma Scale Construct validity Brain Reproducibility of Results Pain scale Middle Aged 3. Good health Anesthesiology and Pain Medicine Nociception Neurology Brain Injuries Physical therapy Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Pain. 160(11) |
| ISSN: | 1872-6623 |
| Popis: | Three clinical scales (the Nociception Coma Scale adapted for Intubated patients [NCS-I], its Revised version [NCS-R-I], and the Behavioral Pain Scale [BPS]) and videopupillometry were compared for measuring pain in intubated, noncommunicating, critically ill, brain-injured patients. Pain assessment was performed before, during, just after, and 5 minutes after 3 procedures: the reference non-nociceptive procedure (assessment of the Richmond Agitation Sedation Scale) and 2 nociceptive procedures (turning and tracheal suctioning). The primary endpoint was construct validity (discriminant and criterion validation), determined by comparing pain measurements between different times/procedures. Secondary endpoints were internal consistency, inter-rater reliability, and feasibility. Fifty patients (54% women, median age 63 years [56-68]) were included 13 [7-24] days after brain injury (76% hemorrhagic or ischemic strokes). All tools increased significantly more (P0.001) during the nociceptive procedures vs the non-nociceptive procedure. The BPS was the only pain tool that did not increase significantly during the non-nociceptive procedure (P = 0.41), suggesting that it was the most discriminant tool. The BPS, NCS-I, and NCS-R-I were good predictors of nociception with areas under the curves ≥0.96, contrary to videopupillometry (area under the curve = 0.67). The BPS, NCS-I, and NCS-I-R had high inter-rater reliabilities (weighted kappa = 0.86, 0.82 and 0.84, respectively). Internal consistency was moderate (0.60) for all pain scales. Factor analysis represented a majority of information on a first dimension, with motor domains represented on a second dimension. Scale feasibility was better for the NCS-I and NCS-R-I than for the BPS. In conclusion, the BPS, NCS-I, and NCS-R-I are valid, reliable, and acceptable pain scales for use in intubated critically ill, brain-injured patients, unlike videopupillometry. Future research requires tool design centered on domains of observation adapted to this very specific population. |
| Databáze: | OpenAIRE |
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