Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale
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To validate an adaptation of the Behavioral Pain Scale (BPS) for its use in non-intubated intensive care unit (ICU) patients unable to self-report their pain because of the occurrence of delirium. The “vocalization” domain was inserted to construct the BPS-non intubated (BPS-NI) scale, ranging from 3 (no pain) to 12 (most pain).
Prospective psychometric study in a medical-surgical ICU.
The same physician and one bedside nurse rated pain in non-intubated patients unable to self-report their pain during four conditions: before and after a catheter dressing change (non-nociceptive procedure) and before and after turning the patient (nociceptive procedure). Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU).
A total of 120 paired evaluations were performed in 30 consecutive adult patients, 84% with delirium (CAM-ICU positive). BPS-NI scores were higher during painful procedures than at rest [6.0 (5.0–8.0) vs. 3.0 (3.0–3.8); P < 0.001], while no changes in BPS-NI scores were found during non-nociceptive procedures (discriminative validity). The BPS-NI had good internal consistency (standardized Cronbach α = 0.79), and each domain reflected the pain expression factor in a balanced way (coefficients between 0.57 and 0.59). The BPS-NI had a good inter-rater reliability (weighted kappa coefficient = 0.89 for the four conditions and 0.82 during nociceptive procedures) and a good responsiveness, with an effect size ranging from 1.5 to 3.6.
Pain during procedures is perceived even in non-intubated ICU patients with delirium. In those patients, pain level can be assessed with the BPS-NI scale since this instrument exhibited good psychometric properties.
KeywordsPain Pain measurement Analgesia Delirium Psychomotor agitation Intensive care Critical care
The authors are grateful for the enthusiastic support of the nurses and assistant nurses of the ICU (SAR B) at Saint Eloi Montpellier University Hospital. The authors are also grateful to Patrick McSweeny for his English editing.
Conflict of interest statement
The authors declare that they have no conflict of interest nor financial supports to disclose.
- 1.Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, Binhas M, Genty C, Rolland C, Bosson JL, Investigators ftD (2007) Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 106:687–695CrossRefPubMedGoogle Scholar
- 5.Desbiens NA, Wu AW, Broste SK, Wenger NS, Connors AF, Lynn J, Yasui Y, Phillips RS, Fulkerson W (1996) Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Crit Care Med 24:1953–1961CrossRefPubMedGoogle Scholar
- 6.Claessens MT, Lynn J, Zhong Z, Desbiens NA, Phillips RS, Wu AW, Harrell FE, Connors AF (2000) Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc 48:S146–S153PubMedGoogle Scholar
- 14.Asika N (1991) Research methodology in the behavioural sciences. Longman, LagosGoogle Scholar
- 18.Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR (2003) monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 289:2983–2991CrossRefPubMedGoogle Scholar
- 21.Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710CrossRefPubMedGoogle Scholar
- 22.Carmines E, Zeller R (1979) Reliability and validity. Sage Publications, Newberry Park, CalifGoogle Scholar
- 23.Fleiss J (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New York Google Scholar
- 25.Kline P (2000) A psychometrics primer. Free Association Books, LondonGoogle Scholar
- 28.Li D, Puntillo K (2004) What is the current evidence on pain and sedation assessment in nonresponsive patients in the intensive care unit? Crit Care Nurse 24:68, 70, 72–73Google Scholar
- 37.Vincent J, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart C, Suter P, Thijs L (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar