The Nociception Coma Scale: a new tool to assess nociception in disorders of consciousness.
Assessing behavioral responses to nociception is difficult in severely brain-injured patients recovering from coma. We here propose a new scale developed for assessing nociception in vegetative (VS) and minimally conscious (MCS) coma survivors, the Nociception Coma Scale (NCS), and explore its concurrent validity, inter-rater agreement and sensitivity. Concurrent validity was assessed by analyzing behavioral responses of 48 post-comatose patients to a noxious stimulation (pressure applied to the fingernail) (28 VS and 20 MCS; age range 20-82 years; 17 of traumatic etiology). Patients' were assessed using the NCS and four other scales employed in non-communicative patients: the 'Neonatal Infant Pain Scale' (NIPS) and the 'Faces, Legs, Activity, Cry, Consolability' (FLACC) used in newborns; and the 'Pain Assessment In Advanced Dementia Scale' (PAINAD) and the 'Checklist of Non-verbal Pain Indicators' (CNPI) used in dementia. For the establishment of inter-rater agreement, fifteen patients were concurrently assessed by two examiners. Concurrent validity, assessed by Spearman rank order correlations between the NCS and the four other validated scales, was good. Cohen's kappa analyses revealed a good to excellent inter-rater agreement for the NCS total and subscore measures, indicating that the scale yields reproducible findings across examiners. Finally, a significant difference between NCS total scores was observed as a function of diagnosis (i.e., VS or MCS). The NCS constitutes a sensitive clinical tool for assessing nociception in severely brain-injured patients. This scale constitutes the first step to a better management of patients recovering from coma.
Coma Science Group, Cyclotron Research Centre, University of Liège, Sart Tilman, B30, 4000 Liège, Belgium Department of Cognitive Sciences, University of Liège, Liège, Belgium Department of Intensive Care, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium Department of Neurology, Centre Hospitalier Universitaire Sart Tilman, Sart Tilman, B30, 4000 Liège, Belgium Fund for Scientific Research - FNRS, Belgium Department of Anesthesia, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium.
Caroline
C
Schnakers
Camille
C
Chatelle
Audrey
A
Vanhaudenhuyse
Steve
S
Majerus
Didier
D
Ledoux
Melanie
M
Boly
Marie-Aurélie
MA
Bruno
Pierre
P
Boveroux
Athena
A
Demertzi
Gustave
G
Moonen
Steven
S
Laureys
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003244:Consciousness Disorders / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult