@article{10902/38981,
year = {2026},
url = {https://hdl.handle.net/10902/38981},
abstract = {Background: Appropriate assessment of pain is essential to ensure effective treatment.
Objectives: The objective of this study was to determine the discriminative ability of the Behavioural Indicators of Pain Scale-Brain Injury (Escala de Conductas Indicadoras de Dolor-Daño Cerebral [ESCID-DC]) under different sedation levels (deep vs. light-to-moderate) and procedures in critically ill patients with acquired brain injury and disorders of consciousness.
Methods: A multicentre, observational study was conducted involving critically ill patients with acquired brain injury and an artificial airway unable to self-report. Patients with prior brain injuries, cognitive impairment, or any condition (clinical or pharmacological) affecting motor response were excluded. The ESCID-DC was administered 5 min before, during, and 15 min after performing painful procedures (tracheal suctioning, right/left nail bed pressure) and a nonpainful procedure (gauze pad rubbing). All assessments were repeated under deep and light-to-moderate sedation.
Results: A total of 418 patients (284 men; 68%) were enrolled. The mean (standard deviation) age was 56.2 (16.3) years. Pain was assessed in 369 patients under deep sedation and in 346 under light-to-moderate sedation. Median (interquartile range) Glasgow Coma Scale scores were 6 (4-7) and 8.5 (7-9) in the deep and light-to-moderate sedation groups, respectively. Under deep sedation, median pain scores during the suctioning and pressure procedures were, respectively, 3 (2-5) and 0 (0-2). Median ESCID-DC scores under light-to-moderate sedation during suctioning and right and left nail bed pressure were 6 (4-7), 3 (1-4), and 3 (1-5), respectively. The ESCID-DC score during the nonpainful procedure was 0. During tracheal suctioning, the discriminative ability of the ESCID-DC was adequate (area under the curve = 0.88; 95% confidence interval: 0.84-0.93), even in patients with very low levels of consciousness. For the pressure procedures, discriminative ability was adequate only when the Glasgow Coma Scale score was 5.
Conclusions: The discriminative ability of the ESCID-DC depends on the level of consciousness and type of procedure. In patients with a low level of consciousness, the scale has a limited capacity to detect pain during less painful procedures.},
organization = {The authors would like to thank the coordinators and collaborating researchers from the 17 participating hospitals for their efforts in recruiting participants. Additionally, Teresa Pérez-Pérez deserves special mention for her great dedication to the project in the analysis and interpretation of the data and her research funded by research grant PID2022-137050NB-I00; Ministerio de Ciencia e Innovación, Spain.},
publisher = {Elsevier},
publisher = {Australian Critical Care, 2026, 39(1), 101510},
title = {Discriminative ability of the Behavioural Indicators of Pain Scale-Brain Injury (Escala de Conductas Indicadoras de Dolor-Daño Cerebral) according to level of sedation in critically ill patients with acquired brain injury and disorders of consciousness: a multicentre observational study},
author = {López-López, Candelas and Robleda-Font, Gemma and Latorre-Marco, Ignacio and Solís-Muñoz, Montserrat and Sarabia Cobo, Carmen María and Arranz-Esteban, Antonio and Paredes-Garza, Francisco and Castanera-Duro, Aaron and Bragado-León, Mónica and Romero de-San-Pío, Emilia and Gil-Saaf, Isabel and Alonso-Crespo, David and Rojas-Ballines, Carolina and Pulido-Martos, María Teresa and Martínez-Yegles, Isabel and Pérez-Pérez, Teresa},
}