title: Validation of the Behavioural Indicators of Pain Scale ESCID for pain assessment in non-communicative and mechanically ventilated critically ill patients: a research protocol.
abstract: OBJECTIVE
  To investigate the validity and reliability of the Behavioural Indicators of Pain Scale (ESCID) in medically and surgically non-communicative and mechanically ventilated critical patients.
  
  
  BACKGROUND
  Scales based on behavioural indicators of pain are suggested to measure pain in non-communicative critically ill patients. Scales proposed thus far have a range not comparable to those used with patients who can report their pain. A scale with a 0-10 range and more behavioural indicators is proposed to improve the detection and measurement of pain.
  
  
  METHODS
  A multicentre prospective observational design to validate a scale-measuring instrument.
  
  
  METHODS
  Three hundred non-communicative and mechanically ventilated critical patients from 20 different intensive care units will be observed for 5 minutes before, during and 15 minutes after three procedures: turning, tracheal suctioning and soft friction with gauze on healthy tissue. Two independent observers will assess the pain of subjects with the Behavioural Pain Scale and the ESCID scale simultaneously. Descriptive and inferential statistics will be used. Student's t-test will be used to compare components of the twos scales. Inter-rater and intrarater agreement will be investigated. The reliability scale will be measured using Cronbach's alpha. Approval date for this protocol was January 2012.
  
  
  CONCLUSIONS
  A greater number of behavioural indicators in the ESCID scale than in previously validated scales, with a 0-10 score range, can improve the detection and measurement of pain in non-communicative and mechanically ventilated critical patients. Funding granted in 2011 by the Spanish Health Research Fund (PI 11/00766, Health Ministry).
  
  
  BACKGROUND
  Study registered with www.clinicaltrials.gov (NCT01744717).
authors.affiliation: Intensive Care Unit, Puerta de Hierro Majadahonda University Hospital (HUPHM), Madrid, Spain.
authors.forename: Ignacio
authors.identifier: http://orcid.org/0000-0002-7528-0890
authors.initials: I
authors.lastname: Latorre-Marco
authors.affiliation: Nursing and Healthcare, Research Area, HUPHM, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Solís-Muñoz
authors.affiliation: Intensive Care Unit, HUPHM, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Acevedo-Nuevo
authors.affiliation: Intensive Care Unit, HUPHM, Spain.
authors.forename: María Leonor
authors.initials: ML
authors.lastname: Hernández-Sánchez
authors.affiliation: Emergency and Trauma Intensive Care Unit, 12 de Octubre University Hospital (HU12O), Madrid, Spain.
authors.forename: Candelas
authors.initials: C
authors.lastname: López-López
authors.affiliation: Intensive Care Unit, Getafe University Hospital (HUG), Madrid, Spain.
authors.forename: María del Mar
authors.initials: Mdel M
authors.lastname: Sánchez-Sánchez
authors.affiliation: Intensive Care Unit, Quirón Madrid University Hospital (HUQ), Madrid, Spain.
authors.forename: Mónika
authors.initials: M
authors.lastname: Wojtysiak-Wojcicka
authors.affiliation: Intensive Care Unit, Gregorio Marañón University Hospital (HGUGM), Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: De las Pozas-Abril
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003147:Communication Disorders; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000451:nursing*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000451:nursing*; D013030:Spain
keywords: behaviour; critically ill; instrument development; mechanical ventilation; nursing; pain assessment; reliability; validity