title: Fluctuations in vital signs and behavioural responses of brain surgery patients in the Intensive Care Unit: are they valid indicators of pain?
abstract: OBJECTIVE
  To examine the validity of behaviours and fluctuations in vital signs for pain assessment of postbrain surgery adults in the neurosurgical intensive care unit.
  
  
  BACKGROUND
  Many patients in an intensive care unit may be unable to self-report their pain. In such cases, the use of observable indicators is recommended. Very little research has explored the validity of the use of behaviours and vital signs for pain assessment of neurocritically ill patients.
  
  
  METHODS
  Prospective repeated-measure within-subject observational design.
  
  
  METHODS
  A total of 43 postbrain surgery patients were video recorded before, during and 15 minutes after a non-nociceptive (non-invasive blood pressure cuff inflation) and a nociceptive (turning) procedures. Their behaviours and vital signs were collected with a pre-tested behavioural checklist and a data collection computer connected to the bedside monitor. The patients' self-report of pain was obtained whenever possible. Data were collected between June-December in 2011.
  
  
  RESULTS
  A larger number of pain-related behaviours were exhibited by participants during the nociceptive procedure compared with the non-nociceptive procedure supporting discriminant validation. Among vital signs, only respiratory rate differed significantly between the two procedures. Regarding criterion validation, only behaviours were positively correlated with self-reports of pain.
  
  
  CONCLUSIONS
  Behaviours were found valid indicators of pain in neurocritically ill patients after elective brain surgery. Fluctuations in vital signs may suggest the presence of pain, but their validity for such use is not supported. They should only be used in combination with other validated pain assessment methods.
authors.affiliation: McGill University, Ingram School of Nursing, Montreal, Quebec, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; McGill University Health Centre (MUHC), Montreal, Quebec, Canada.
authors.forename: Oxana
authors.initials: O
authors.lastname: Kapoustina
authors.forename: Christine
authors.initials: C
authors.lastname: Echegaray-Benites
authors.forename: Céline
authors.initials: C
authors.lastname: Gélinas
mesh_terms: D001519:Behavior; D001921:Brain / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies
keywords: assessment; critical care; neurosurgery; nurses; nursing; pain; vital signs