A sensitive scale to assess nociceptive pain in patients with disorders of consciousness.
OBJECTIVE
To determine the sensitivity of the Nociception Coma Scale (NCS), the first scale developed to assess nociceptive pain in vegetative state and minimally conscious state patients, in comparing behavioural changes in response to noxious versus non-noxious stimulation.


METHODS
The NCS was administered to assess patients' responses in three conditions: (1) baseline (observation of spontaneous behaviours), (2) non-noxious/tactile stimulation (taps on the patient's shoulder), and (3) noxious stimulation (pressure on the nail bed).


RESULTS
We included 64 patients (27 vegetative state and 37 minimally conscious state; age range 20-82 years; 22 traumatic brain injury; 21 in the acute stage). The NCS total scores and subscores (motor, verbal and facial) were higher for the noxious versus the non-noxious stimulation conditions. We did not observe a difference between the non-noxious and the noxious stimulation conditions for the visual subscale. We also found a NCS cut-off value of 4 differentiating the patients receiving a noxious stimulation from patients receiving a non-noxious stimulation. The exclusion of the visual subscale increased the cut-off sensitivity (from 46% to 73%; specificity of 97% and accuracy of 85%).


CONCLUSIONS
We propose a new version of the NCS excluding the visual subscale, the NCS-R, which constitutes a highly sensitive tool to assess responses to nociceptive pain in severely brain injured patients.
Coma Science Group, Cyclotron Research Centre, University of Liège, 4000 Liège, Belgium.
Camille
C
Chatelle
Steve
S
Majerus
John
J
Whyte
Steven
S
Laureys
Caroline
C
Schnakers
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003128:Coma / Q000503:physiopathology; D003244:Consciousness Disorders / Q000150:complications*; D005149:Facial Expression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D059226:Nociceptive Pain / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement / Q000379:methods*; D010812:Physical Stimulation; D014785:Vision, Ocular / Q000502:physiology; D055815:Young Adult