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.
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