JOURNAL ARTICLE

Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale

Gérald Chanques, Jean-François Payen, Grégoire Mercier, Sylvie de Lattre, Eric Viel, Boris Jung, Moussa Cissé, Jean-Yves Lefrant, Samir Jaber
Intensive Care Medicine 2009, 35 (12): 2060-7
19697008

PURPOSE: 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).

DESIGN: Prospective psychometric study in a medical-surgical ICU.

METHODS: 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).

RESULTS: 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 alpha = 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.

CONCLUSIONS: 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. Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1590-5) contains supplementary material, which is available to authorized users.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
19697008
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"