Aim: To develop and psychometrically test the Behavioural Indicators of Pain Scale (ESCID) in patients with traumatic brain injury (TBI).
Design: A prospective observational study to test the psychometric properties of the Behavioural Indicators of Pain Scale in patients with TBI.
Method: A convenience sample of patients with TBI, who were non-communicative and using invasive mechanical ventilation was selected. Pain was evaluated by two observers who were blinded from each other. Assessments were performed at baseline via the performance of a painful procedure (aspiration of secretions) and a non-painful procedure (rubbing with a gauze). Assessments were repeated after application of procedures on days 1 and 6 of hospitalization in an intensive care unit. Data were collected between January-December 2016.
Results: About 134 patients were included in the study. Of these, 76.1% were men. The mean age of participants was 45.2 (SD 17.5) years. The pain score significantly increased during the painful procedure when compared with the baseline measure and non-painful procedure (p < .001). Patients displayed a greater number of pain-indicating behaviours during the painful procedure on day 6, compared with day 1 (p < .05). This finding coincided with a reduced level of sedation and a greater level of consciousness.
Conclusion: The ESCID scale detects pain behaviours and discriminates among the different types of stimulation in patients with brain injury, who are uncommunicative and with mechanical ventilation, with good reliability. The ability for patients with brain injury to express behaviours is limited because of the low level of consciousness and the deep level of sedation.
Impact: This research will have an impact on the practice of pain assessment in patients with brain injury, representing a first step to adapt the content of the ESCID.
目的: 建立外伤性脑损伤(TBI)患者疼痛量表行为指标(ESCID)并进行心理测量。 设计: 以测试外伤性脑损伤患者疼痛量表行为指标的心理测量特性的前瞻性观察研究。 方法: 随机抽样一个外伤性脑损伤患者样本,他们是无法进行交流,且使用有创机械通气。由两名观察者对疼痛感进行独立盲评。在基线位置,通过疼痛性过程(吸入分泌物)和非疼痛性过程(用纱布摩擦)进行评估。在重症监护病房住院的第1天和第6天应用这些过程后,重复评估。 收集2016年1月至12月的数据。 结果: 本研究共纳入134例患者。其中男性占76.1%。受访者的平均年龄为45.2岁(标准差为17.5岁)。在与基线测量和非疼痛性过程比较时,疼痛过程的疼痛评分明显偏高(p <0.001)。与第1天相比,疼痛过程的患者在第6天的表现出的疼痛指示行为更高(p <0.05)。这一发现与镇静程度的降低和意识水平的增强相吻合。 结论: 疼痛量表行为指标量表能检测无法进行交流且使用机械通气的外伤性脑损伤患者的疼痛行为,区分不同类型的刺激物,结果更加可靠。外伤性脑损伤患者由于意识水平低、镇静程度深,表达行为的能力有限。 影响: 本研究将对外伤性脑损伤患者疼痛评估的实践产生影响,预示着其适合疼痛量表行为指标内容的第一步。.
Keywords: instrument development; intensive care unit; nursing; pain; traumatic brain injury.
© 2020 John Wiley & Sons Ltd.