A Comparison of Pain Scales in Patients with Disorders of Consciousness Following Craniotomy.
OBJECTIVE
Evaluate the validity, reliability, and practicality of pain assessment tools in patients with disorders of consciousness who underwent craniotomy.


METHODS
This prospective observational study cross-validated three pain scales, FLACC (Face, Legs, Activity, Cry, Consolability), rFLACC (Revised FLA CC), and NCS (Nociception Coma Scale), based on validity, reliability, and practicality. After translation, the three pain scales were tested for concurrent validity, construct validity, and interrater reliability in patients who experienced disorders of consciousness within 24 hours following craniotomy. Opinions regarding practicality were elicited via questionnaire from nurses who have used and are familiar with these pain scales.


RESULTS
Fifty-eight patients were enrolled in the present study. Concurrent validity was supported by positive correlations among all scales, which ranged from r = 0.638 to r = 0.978. All scales yielded fair to moderate agreement (K = 0.380-0.626) with routine clinical decision to treat postoperative pain. Concurrent validity was much improved in the assessment of intubated patients. Construct validity was demonstrated by high scores (3-5) in higher pain situations before analgesic was given and low pain scores (0) in pain-free situations after analgesic was given. All scales had good interrater reliability (intraclass correlation = 0.7506-0.8810).


CONCLUSIONS
All pain scales were found to be valid and reliable, especially in intubated patients. In terms ofpracticality, NCS was found to be the most acceptable by practitioners.
Suwannee
S
Suraseranivongse
Pensook
P
Yuvapoositanont
Paphatsorn
P
Srisakkrapikoop
Ruetaichanok
R
Pommul
Waraporn
W
Phaka
Parunut
P
Itthimathin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D003244:Consciousness Disorders / Q000209:etiology*; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult
D000700:Analgesics