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

IF 1.1 Q3 NURSING

Enfermeria Intensiva Pub Date : 2025-02-24 DOI:10.1016/j.enfi.2025.500523

Candelas López-López RN, MSc, PhD , Gemma Robleda-Font RN, MSc, PhD , Antonio Arranz-Esteban RN , Teresa Pérez-Pérez PhD , Montserrat Solís-Muñoz RN, MSc, PhD , María Carmen Sarabia-Cobo RN, MSc, PhD , María Jesús Frade-Mera RN, MSc, PhD , Susana Temprano-Vázquez MD , Francisco Paredes-Garza RN, MSc, PhDcandidate , Aaron Castanera-Duro RN, MSc, PhD , Mónica Bragado-León RN , Emilia Romero de-San-Pío RN, MSc , Isabel Gil-Saaf RN , David Alonso-Crespo RN, MSc, PhDcandidate , Carolina Rojas-Ballines RN , Ignacio Latorre-Marco RN , Grupo ESCID-DC

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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.

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开发和验证脑疼痛-损伤行为量表（ESCID-DC），用于评估获得性脑损伤、无法自我报告和使用人工空气的危重患者的疼痛

本研究的目的是开发和验证疼痛量表行为指标（ESCID）对无法自我报告并使用人工气道的获得性脑损伤（ESCID- dc）患者的适应性。方法采用多中心研究方法，分量表开发和心理测量特性评估两个阶段进行。两名盲法观察者同时用两种量表评估疼痛行为：ESCID-DC和创伤性昏迷量表-修订版-插管患者适用（NCS-R-I）。在3个时间点进行评估：应用疼痛操作（气管吸吸并向左右甲床施加压力）前5分钟、期间和15分钟后以及无痛操作（用纱布摩擦）。测量当天分别进行格拉斯哥昏迷评分（GCS）和里士满躁动镇静量表（RASS）评估。进行了描述性和心理测量分析。结果346例患者共进行了4152次疼痛评估，其中70%为男性，平均年龄56岁（SD = 16.4）。脑损伤最常见的病因是血管性155例（44.8%）和外伤性144例（41.6%）。评估当天的中位GCS和RASS分别为8.50 （IQR = 7 ~ 9）和- 2 （RIQ = - 3 ~ - 2）。在ESCID-DC中，抽吸时中位评分为6 (IQR = 4 ~ 7)，右压时中位评分为3 (RIQ = 1 ~ 4)，左压时中位评分为3 （RIQ = 1 ~ 5）。在无痛过程中，它是0。ESCID-DC显示出对疼痛和非疼痛过程的高度区分能力(AUC >；0.83)，并且对随使用时间的变化很敏感。高度观察员间协议(Kappa >；0.87)，手术过程中具有良好的内部一致性（α-Cronbach≥0.80），ESCID-DC与NCS-R-I具有较高的相关性（r≥0.75）。结论本研究结果表明，ESCID-DC是评估获得性脑损伤患者疼痛的有效和可靠的工具，无法自我报告和人工气道。

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来源期刊

Enfermeria Intensiva NURSING-

CiteScore

2.50

自引率

23.10%

发文量

期刊介绍： Enfermería Intensiva es el medio de comunicación por antonomasia para todos los profesionales de enfermería españoles que desarrollan su actividad profesional en las unidades de cuidados intensivos o en cualquier otro lugar donde se atiende al paciente crítico. Enfermería Intensiva publica cuatro números al año, cuyos temas son específicos para la enfermería de cuidados intensivos. Es la única publicación en español con carácter nacional y está indexada en prestigiosas bases de datos como International Nursing Index, MEDLINE, Índice de Enfermería, Cuiden, Índice Médico Español, Toxline, etc.