Desarrollo y validación psicométrica de la Escala de Conductas Indicadoras de Dolor-Daño Cerebral (ESCID-DC) para la evaluación del dolor en pacientes críticos con daño cerebral adquirido, incapaces de autoinformar y con vía aérea artificial

Abstract

Introduction

The aim of this study was to develop and validate the adaptation of the behavioral indicators of pain scale (ESCID) for patients with acquired brain injury (ESCID-DC), unable to self-report and with artificial airway.

Methods

Multicenter study conducted in two phases: scale development and evaluation of psychometric properties. Two blinded observers simultaneously assessed pain behaviors with two scales: ESCID-DC and Nociception Coma Scale-Revised version-adapted for Intubated patients (NCS-R-I). Assessments were performed at 3 time points: 5 minutes before, during and 15 minutes after the application of the painfull procedures (tracheal suction and application of pressure to the right and left nail bed) and a non-painful procedure (rubbing with gauze). On the day of measurement, the Glasgow Coma Score (GCS) and the Richmond Agitation Sedation Scale (RASS) were evaluated. A descriptive and psychometric analysis was performed.

Results

A total of 4,152 pain evaluations were performed in 346 patients, 70% men with a mean age of 56 years (SD = 16.4). The most frequent etiologies of brain damage were vascular 155 (44.8%) and traumatic 144 (41.6%). The median GCS and RASS on the day of evaluation were 8.50 (IQR = 7 to 9) and −2 (RIQ = −3 to −2) respectively. In ESCID-DC the median score was 6 (IQR = 4 to 7) during suction, 3 (RIQ = 1 to 4) for right pressure and 3 (RIQ = 1 to 5) for left pressure. During the non-painful procedure it was 0. The ESCID-DC showed a high discrimination capacity between painful and non-painful procedures (AUC > 0.83) and is sensitive to change depending on the time of application of the scale. High interobserver agreement (Kappa > 0.87), good internal consistency during procedures (α-Cronbach ≥ 0.80) and a high correlation between the ESCID-DC and the NCS-R-I (r ≥ 0.75) were obtained.

Conclusions

The results of this study demonstrate that the ESCID-DC is a valid and reliable tool for assessing pain in patients with acquired brain injury, unable to self-report and with artificial airway.