The primary objective of this study was to describe the frequency of behaviors observed during rest, a non-nociceptive procedure, and a nociceptive procedure in brain-injured intensive care unit ICU patients with different levels of consciousness LOC. Second, it examined the inter-rater reliability and discriminant and concurrent validity of the behavioral checklist used. The nociceptive procedure involved turning the patient. The frequency of behaviors was recorded using a behavioral checklist.
Patients with absence of movement, or stereotyped flexion or extension responses to a nociceptive stimulus displayed more behaviors during turning median 5. Face flushing, clenched teeth, clenched fist, and tremor were more frequent in patients with absence of movement, or stereotyped responses to a nociceptive stimulus. The reliability of the checklist was supported by a high intra-class correlation coefficient 0.
Discriminant validity was supported as significantly more behaviors were observed during nociceptive stimulation than at rest. Brain-injured patients reacted significantly more during a nociceptive stimulus and the number of observed behaviors was higher in patients with a stereotyped response.
In brain-injured patients, pain is a major concern as it can alter cerebral perfusion and therefore increase the risk of brain damage [ 2 ]. In order to provide adequate pain relief, sedatives and analgesics must be administered; however, these drugs can mask clinical signs of neurological complications [ 2 , 3 ].
Therefore, it is essential to accurately assess pain in order to achieve adequate pain relief without jeopardizing neurological assessment. Several studies have validated behavioral pain assessment tools recommended and adapted for the general intensive care unit ICU population unable to self-report [ 4 — 8 ]. The implementation of these assessment tools improves pain management and patient outcomes [ 9 , 10 ]. The few validated tools available for the assessment of pain in ICU adult patients [ 11 , 12 ] may not be appropriate for brain-injured patients as they exhibit different pain behaviors [ 8 , 13 , 14 ].
