title: Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients.
abstract: OBJECTIVE
  To assess the psychometric properties of the behavioral indicators of pain scale (ESCID) when applied to a wide range of medical and surgical critical patients.
  
  
  METHODS
  A multicentre, prospective observational study was designed to validate a scale measuring instrument.
  
  
  METHODS
  Twenty Intensive Care Units of 14 hospitals belonging to the Spanish National Health System.
  
  
  METHODS
  A total of 286 mechanically ventilated, unable to self-report critically ill medical and surgical adult patients.
  
  
  METHODS
  Pain levels were measured by two independent evaluators simultaneously, using two scales: ESCID and the behavioral pain scale (BPS). Pain was observed before, during, and after two painful procedures (turning, tracheal suctioning) and one non-painful procedure.
  
  
  METHODS
  ESCID reliability was measured on the basis of internal consistency using the Cronbach-α coefficient. Inter-rater and intra-rater agreement were measured. The Spearman correlation coefficient was used to assess the correlation between ESCID and BPS.
  
  
  RESULTS
  A total of 4386 observations were made in 286 patients (62% medical and 38% surgical). High correlation was found between ESCID and BPS (r=0.94-0.99; p<0.001), together with high intra-rater and inter-rater concordance. ESCID was internally reliable, with a Cronbach-α value of 0.85 (95%CI 0.81-0.88). Cronbach-α coefficients for ESCID domains were high: facial expression 0.87 (95%CI 0.84-0.89), calmness 0.84 (95%CI 0.81-0.87), muscle tone 0.80 (95%CI 0.75-0.84), compliance with mechanical ventilation 0.70 (95%CI 0.63-0.75) and consolability 0.85 (95%CI 0.81-0.88).
  
  
  CONCLUSIONS
  ESCID is valid and reliable for measuring pain in mechanically ventilated unable to self-report medical and surgical critical care patients. CLINICALTRIALS.GOV: NCT01744717.
authors: Medical Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain. Electronic address: ntx_2002@yahoo.es.
authors: I
authors: I
authors: Latorre-Marco
authors: Medical Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
authors: M
authors: M
authors: Acevedo-Nuevo
authors: Nursing and Healthcare, Research Area, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
authors: M
authors: M
authors: Solís-Muñoz
authors: Medical Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
authors: L
authors: L
authors: Hernández-Sánchez
authors: Emergency and Trauma Intensive Care Unit, Hospital Universitario Doce de Octubre, Madrid, Spain.
authors: C
authors: C
authors: López-López
authors: Intensive Care Unit, Hospital Universitario de Getafe, Getafe, Spain.
authors: M M
authors: MM
authors: Sánchez-Sánchez
authors: Intensive Care Unit, Hospital Universitario Quirón Madrid, Pozuelo de Alarcón, Spain.
authors: M
authors: M
authors: Wojtysiak-Wojcicka
authors: Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: J
authors: J
authors: de Las Pozas-Abril
authors: Intensive Care Unit, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain.
authors: G
authors: G
authors: Robleda-Font
authors: Intensive Care Unit, Hospital Universitario Doce de Octubre, Madrid, Spain.
authors: M J
authors: MJ
authors: Frade-Mera
authors: Postsurgical Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
authors: R
authors: R
authors: De Blas-García
authors: Postsurgical Intensive Care Unit, Hospital Universitario de Basurto, Bilbao, Spain.
authors: C
authors: C
authors: Górgolas-Ortiz
authors: Intensive Care Unit, Hospital Universitario de La Princesa, Madrid, Spain.
authors: J
authors: J
authors: De la Figuera-Bayón
authors: Intensive Care Unit, Hospital Universitario de Cruces, Barakaldo, Spain.
authors: C
authors: C
authors: Cavia-García
mesh_terms: D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D010146:Pain; D010147:Pain Measurement; D011446:Prospective Studies; D011594:Psychometrics; D015203:Reproducibility of Results
keywords: Behavior; Conductual; Critically ill patients; Dolor; Escala; Fiabilidad; Mechanical ventilation; Paciente crítico; Pain assessment; Reliability; Scale; Validez; Validity; Ventilación mecánica