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

Details

Serval ID
serval:BIB_F5E22B29275F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: an observational study.
Journal
Intensive Care Medicine
Author(s)
Roulin M.J., Ramelet A.S.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
2014
Volume
40
Number
8
Pages
1115-1123
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
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.
Pubmed
Web of science
Create date
08/08/2014 7:19
Last modification date
20/08/2019 17:22
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