To develop and psychometrically test the Behavioral Indicators of Pain Scale (ESCID) in patients with traumatic brain injury DESIGN: A prospective observational study to test the psychometric properties of the Behavioral Indicators of Pain Scale in patients with traumatic brain injury.
A convenience sample of patients with traumatic brain injury, who were non-communicative and using invasive mechanical ventilation. 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 one and six of hospitalization in an intensive care unit. Data were collected between January and December 2016.
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 compared with the non-painful procedure (p<0.001). Patients displayed a greater number of pain-indicating behaviors during the painful procedure on day six, compared with day one (p<0.05). This finding coincided with a reduced level of sedation and a greater level of consciousness.
The ESCID scale detects pain behaviors 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 behaviors is limited because of the low level of consciousness and the deep level of sedation.
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 to patients with brain injury.

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