Assessing pain in critically ill brain-injured patients: a psychometric comparison of three pain scales and videopupillometry.

08:00 EDT 10th June 2019 | BioPortfolio

Summary of "Assessing pain in critically ill brain-injured patients: a psychometric comparison of three pain scales and videopupillometry."

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, non-communicating, critically ill, brain-injured (CIBI) patients. Pain assessment was performed before, during, just after and 5-min after three procedures: the reference non-nociceptive procedure (assessment of the Richmond-Agitation-Sedation-Scale), and two 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, interrater reliability and feasibility. Fifty patients (54% women, median age 63-yr [56-68]) were included 13 [7-24] days after brain-injury (76% hemorrhagic or ischemic strokes). All tools increased significantly more (p<0.001) during the nociceptive procedures versus 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. BPS, NCS-I and NCS-R-I were good predictors of nociception with areas-under-thecurves (AUC) ≥0.96, contrary to videopupillometry (AUC=0.67). The BPS, NCS-I and NCS-I-R had high interrater 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 NCS-I and NCS-R-I than for BPS. In conclusion, BPS, NCS-I and NCS-R-I are valid, reliable and acceptable pain-scales for use in intubated CIBI patients, unlike videopupillometry. Future research requires tool design centered on domains of observation adapted to this very specific population.


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This article was published in the following journal.

Name: Pain
ISSN: 1872-6623


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