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Anesth Analg 2005;101:1470-1476
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000182331.68722.FF

CRITICAL CARE AND TRAUMA

Validation of a Behavioral Pain Scale in Critically Ill, Sedated, and Mechanically Ventilated Patients

Younès Aïssaoui, MD*, Amine Ali Zeggwagh, MD, PhD*{dagger}, Aïcha Zekraoui, MD*, Khalid Abidi, MD*, and Redouane Abouqal, MD, PhD*{dagger}

*Service de Réanimation Médicale et de Toxicologie Clinique, Hôpital Ibn Sina; and {dagger}Laboratoire de Biostatistiques, de Recherche Clinique et Epidémiologique, Faculté de Médecine et de Pharmacie, Rabat, Morocco

Address correspondence and reprint requests to Younès Aissaoui, MD, Service de Réanimation Médicale et Toxicologie Clinique, BP 1005, Hôpital Ibn Sina, 10001 Rabat, Morocco. Address e-mail to shadowyounes{at}hotmail.com.

Assessing pain in critically ill patients, particularly in nonverbal patients, is a great challenge. In this study, we validated a behavioral pain scale (BPS) in critically ill, sedated, and mechanically ventilated patients. The BPS score was the sum of 3 subscales that have a range score of 1–4: facial expression, upper limb movements, and compliance with mechanical ventilation. Two assessors observed and scored pain simultaneously with the BPS at rest and during painful procedures. The psychometric properties of the BPS that were studied were reliability, validity, and responsiveness. We achieved 360 observations in 30 patients. The BPS was internally reliable (Cronbach {alpha} = 0.72). The intraclass correlation coefficient to evaluate inter-rater reliability was high (0.95). Validity was demonstrated by the change in BPS scores, which were significantly higher during painful procedures, with averages of 3.9 ± 1.1 at rest and 6.8 ± 1.9 during procedures (P < 0.001), and by the principal components factor analysis, which revealed a large first-factor accounting for 65% of the variance in pain expression. The BPS exhibited excellent responsiveness, with an effect size ranging from 2.2 to 3.4. This study demonstrated that the BPS can be valid and reliable for measuring pain in noncommunicative intensive care unit patients.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.