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Intensive Care Medicine

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01-08-2014 | Original

Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: an observational study

Authors: Marie-José Roulin, Anne-Sylvie Ramelet

Published in: Intensive Care Medicine | Issue 8/2014

Abstract

Purpose

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.

Methods

The non-nociceptive procedure involved calling the patient and shaking his/her shoulder. The nociceptive procedure involved turning the patient. The frequency of behaviors was recorded using a behavioral checklist.

Results

Patients with absence of movement, or stereotyped flexion or extension responses to a nociceptive stimulus displayed more behaviors during turning (median 5.5, range 0–14) than patients with localized responses (median 4, range 0–10) or able to self-report their pain (median 4, range 0–10). 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 (0.77–0.92), and the internal consistency was acceptable in all three groups (KR 20, 0.71–0.85). Discriminant validity was supported as significantly more behaviors were observed during nociceptive stimulation than at rest. Concurrent validity was confirmed as checklist scores were correlated to the patients’ self-reports of pain (r _s = 0.53; 95 % CI 0.21–0.75).

Conclusion

Brain-injured patients reacted significantly more during a nociceptive stimulus and the number of observed behaviors was higher in patients with a stereotyped response.

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Title: Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: an observational study
Authors: Marie-José Roulin
Anne-Sylvie Ramelet
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 8/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3380-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: an observational study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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