Assessing pain in critically ill brain-injured patients: a psychometric comparison of 3 pain scales and videopupillometry

Christine Bernard; Valentine Delmas; Claire Duflos; Nicolas Molinari; Océane Garnier; Kevin Chalard; Samir Jaber; Pierre-François Perrigault; Gérald Chanques

doi:10.1097/j.pain.0000000000001637

journal article Jun 10, 2019

Assessing pain in critically ill brain-injured patients: a psychometric comparison of 3 pain scales and videopupillometry

Christine Bernard Valentine Delmas Claire Duflos

Nicolas Molinari Océane Garnier Kevin Chalard Samir Jaber

Pierre-François Perrigault Gérald Chanques

Pain Vol. 160 No. 11 pp. 2535-2543 · Ovid Technologies (Wolters Kluwer Health)

View at Publisher Save 10.1097/j.pain.0000000000001637

Abstract

Abstract
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 (P < 0.001) 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.

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Metrics

24

Citations

43

References

Details

Published: Jun 10, 2019
Vol/Issue: 160(11)
Pages: 2535-2543

Authors

C

Christine Bernard

Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France

V

Valentine Delmas

Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France

C

Claire Duflos

Department of Medical Information and Statistics, Montpellier University Hospital La Colombière, Institut Montpelliérain Alexander Grothendieck (IMAG), University of Montpellier, CNRS, Montpellier, France

N

Nicolas Molinari

Department of Medical Information and Statistics, Montpellier University Hospital La Colombière, Institut Montpelliérain Alexander Grothendieck (IMAG), University of Montpellier, CNRS, Montpellier, France

O

Océane Garnier

Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France; Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Saint Eloi, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France

K

Kevin Chalard

Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France

S

Samir Jaber

Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Saint Eloi, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France

P

Pierre-François Perrigault

Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France

G

Gérald Chanques

Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Gui de Chauliac, Montpellier, France; Department of Anesthesia and Critical Care Medicine, Montpellier University Hospital Saint Eloi, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France

Cite This Article

Christine Bernard, Valentine Delmas, Claire Duflos, et al. (2019). Assessing pain in critically ill brain-injured patients: a psychometric comparison of 3 pain scales and videopupillometry. Pain, 160(11), 2535-2543. https://doi.org/10.1097/j.pain.0000000000001637

Assessing pain in critically ill brain-injured patients: a psychometric comparison of 3 pain scales and videopupillometry

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