Institute of Higher Education and Nursing Research, Lausanne University-CHUV, 1010 Lausanne, Switzerland,
Intensive Care Med. 2014 Aug;40(8):1115-23. doi: 10.1007/s00134-014-3380-y. Epub 2014 Jul 10.
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.
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.
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).
Brain-injured patients reacted significantly more during a nociceptive stimulus and the number of observed behaviors was higher in patients with a stereotyped response.
本研究的主要目的是描述不同意识水平（LOC）的脑损伤重症监护病房（ICU）患者在休息、非伤害性和伤害性过程中的行为频率。其次，检验了所使用行为检查表的组内信度、判别和同时效度。
非伤害性过程包括呼唤患者并摇动其肩部。伤害性过程包括翻动患者。使用行为检查表记录行为频率。
对伤害性刺激无运动或刻板屈肌/伸肌反应的患者在翻动时表现出更多的行为（中位数 5.5，范围 0-14），而有局部反应（中位数 4，范围 0-10）或能够自我报告疼痛的患者（中位数 4，范围 0-10）表现出较少的行为。面红、咬牙、握拳和震颤在对伤害性刺激无运动或刻板反应的患者中更为常见。检查表的可靠性得到了较高的组内相关系数（0.77-0.92）的支持，在所有三组中内部一致性均可接受（KR 20，0.71-0.85）。判别效度得到支持，因为在伤害性刺激期间观察到的行为明显多于休息时。同时效度得到证实，检查表评分与患者自我报告的疼痛相关（rs=0.53；95%CI 0.21-0.75）。
脑损伤患者在伤害性刺激时反应明显更多，且刻板反应患者的观察行为数量更高。
