title: Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: an observational study.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Brain-injured patients reacted significantly more during a nociceptive stimulus and the number of observed behaviors was higher in patients with a stereotyped response.
authors.affiliation: Institute of Higher Education and Nursing Research, Lausanne University-CHUV, 1010 Lausanne, Switzerland, marie-jose.roulin@hcuge.ch.
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Roulin
authors.forename: Anne-Sylvie
authors.initials: AS
authors.lastname: Ramelet
mesh_terms: D001519:Behavior; D001930:Brain Injuries / Q000503:physiopathology*; D003243:Consciousness; D003422:Critical Care; D006801:Humans; D059225:Nociception / Q000502:physiology*; D015588:Observer Variation; D010812:Physical Stimulation; D015203:Reproducibility of Results