Evaluating Pain, Sedation, and Delirium in the Neurologically Critically Ill—Feasibility and Reliability of Standardized Tools

Abstract

Pain and sedation can be systematically assessed in the neurologically critically ill; the majority can also be screened for delirium features with excellent inter-rater reliability. Increased proportion of Intensive Care Delirium Screening Checklist items is associated with worse outcomes.

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…In the brain-injured population, although the construct validity of both scales is supported with higher scores during painful procedures (vs rest and nonpainful procedures), patients predominantly expressed pain-related behaviors that were related to level of consciousness; grimacing and muscle rigidity were less frequently observed (50,(52)(53)(54). An additional study (51), although not evaluating validity, found that BPS and BPS-NI were feasible and reliable to use in the brain-injured population. Of note, Behavioral Pain Scales have been validated in the following languages (other than French or English): CPOT-Mandarin (55), Korean (56), Spanish (57), and Swedish (58); BPS and BPS-NI-Mandarin (59).…”

“…The BPS-NI obtained a psychometric weighted score of 14.8. Although both the BPS and the CPOT have been validated across large samples of medical, surgical, and trauma ICUs (50)(51)(52)(53)(54), studies involving brain-injured patients using the BPS (50,51) and CPOT (52)(53)(54) are small. In the brain-injured population, although the construct validity of both scales is supported with higher scores during painful procedures (vs rest and nonpainful procedures), patients predominantly expressed pain-related behaviors that were related to level of consciousness; grimacing and muscle rigidity were less frequently observed (50,(52)(53)(54).…”

“…A recent systematic review has updated the psychometric properties of delirium screening tools for critically ill adults (301). The sensitivity and specificity of delirium screening tools when compared with clinical assessment, and their reproducibility and reliability when screening tools are substituted for a clinical diagnosis vary between ICU populations (e.g., cardiac surgery ICU or neurologically injured patients) (51,302,303). A recent publication (304) describes a new validated tool (the ICU-7) to document delirium severity and suggests that severity is associated with worse outcome.…”

Use of Dexmedetomidine for Prophylactic Analgesia and Sedation in Patients With Delayed Extubation After Craniotomy: A Randomized Controlled Trial

“…The visual analog scale (VAS) (VAS=0, not bad at all and well tolerable;VAS=10, very painful and beyond endurance) was evaluated immediately before extubation and 30 minutes after extubation 2,23. These parameters were measured and documented by the chief nurses (Y.Y.…”

2013: Updates in Delirium

“…Along with pain and sedation, this study further demonstrates that delirium measures endorsed in the PAD guidelines can be used for systematic delirium screening among neurologically critically ill patients. 7 …”