A comparison of pain scales in patients with disorders of consciousness following craniotomy

Abstract

© 2015, Medical Association of Thailand. All rights reserved. Objective: Evaluate the validity, reliability, and practicality of pain assessment tools in patients with disorders of consciousness who underwent craniotomy. Material and Method: This prospective observational study cross-validated three pain scales, FLACC (Face, Legs, Activity, Cry, Consolability), rFLACC (Revised FLACC), and NCS (Nociception Coma Scale), based on validity, reliability, and practicality. After translation, the three pain scales were tested for concurrent validity, construct validity, and interrater reliability in patients who experienced disorders of consciousness within 24 hours following craniotomy. Opinions regarding practicality were elicited via questionnaire from nurses who have used and are familiar with these pain scales. Results: Fifty-eight patients were enrolled in the present study. Concurrent validity was supported by positive correlations among all scales, which ranged from r = 0.638 to r = 0.978. All scales yielded fair to moderate agreement (K = 0.380-0.626) with routine clinical decision to treat postoperative pain. Concurrent validity was much improved in the assessment of intubated patients. Construct validity was demonstrated by high scores (3-5) in higher pain situations before analgesic was given and low pain scores (0) in pain-free situations after analgesic was given. All scales had good interrater reliability (intraclass correlation = 0.7506-0.8810). Conclusion: All pain scales were found to be valid and reliable, especially in intubated patients. In terms of practicality, NCS was found to be the most acceptable by practitioners.