疼痛量表-脑损伤行为指标(ESCID-DC)用于评估获得性脑损伤、无法自我报告和使用人工气道的危重患者疼痛的制定和心理测量学验证

Candelas López-López , Gemma Robleda-Font , Antonio Arranz-Esteban , Teresa Pérez-Pérez , Montserrat Solís-Muñoz , María Carmen Sarabia-Cobo , María Jesús Frade-Mera , Susana Temprano-Vázquez , Francisco Paredes-Garza , Aaron Castanera-Duro , Mónica Bragado-León , Emilia Romero de-San-Pío , Isabel Gil-Saaf , David Alonso-Crespo , Carolina Rojas-Ballines , Ignacio Latorre-Marco , Grupo ESCID-DC
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引用次数: 0

摘要

本研究的目的是开发和验证疼痛量表(ESCID)行为指标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(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 min,期间和15 min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)。ESCID-DC抽吸时中位评分为6分(IQR = 4 ~ 7),右压时中位评分为3分(RIQ = 1 ~ 4),左压时中位评分为3分(RIQ = 1 ~ 5)。在无痛过程中,它是0。ESCID-DC在疼痛和非疼痛过程之间表现出较高的区分能力(AUC >; 0.83),并且对随应用时间的变化敏感。观察间一致性高(Kappa >; 0.87),手术过程内部一致性好(α-Cronbach≥0.80),essid - dc与NCS-R-I高度相关(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。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development and psychometric validation of the Behavioral Indicators of Pain Scale-Brain Injury (ESCID-DC) for pain assessment in critically ill patients with acquired brain injury, unable to self-report and with artificial airway

Introduction

The aim of this study was to develop and validate the adaptation of the behavioural 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 2 phases: scale development and evaluation of psychometric properties. Two blinded observers simultaneously assessed pain behaviours 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 min before, during and 15 min 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 4152 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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