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Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients

López-López, Candelas, PhD; Pérez-Pérez, Teresa, PhD; Beneit-Montesinos, Juan, Vicente, PhD; García-Klepzig, José, Luis, PhD; Martinez-Ureta, Mercedes, Virginia, RN; Murillo-Pérez, María del, Ara, MSc; Torrente-Vela, Silvia, Ana, RN; García-Iglesias, Mónica, RN

doi: 10.1097/JTN.0000000000000342

The aim of this study was to measure pain levels in noncommunicative patients with severe trauma who required tracheal suctioning and mobilization and to determine the utility of the Behavioral Indicators of Pain Scale (ESCID) in these cases. The pain scores for the procedures were recorded on Days 1, 3, and 6 of the patients' stay in the intensive care unit. These assessments were performed at 3 moments: before, during, and after the application of the procedures. Because of the longitudinal character of the study, data were fitted into a multivariate model using the Generalized Estimating Equations method. The sample of 124 patients comprised 77.4% males and 22.6% females with an average age of 45.93 (SD = 16.43) years. A significant increase (p < .01) in the ESCID score was observed during the application of the procedures that produced similar pain levels. Kappa coefficient value obtained for interobserver agreement of ESCID scale scores during the application of care procedures at the intervals being evaluated was greater than 0.84, which should be interpreted as almost perfect. The ESCID scores increased during 2 care procedures that are frequently carried out in intensive care units and indicated that they produced similar pain levels.

Emergency and Trauma Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain (Dr López-López and Mss Martinez-Ureta, Murillo-Pérez, Torrente-Vela, and García-Iglesias); Department of Statistics and OR III (Dr Pérez-Pérez) and Nursery, Physiotherapy and Podiatry Facultie (Dr Beneit-Montesinos), Complutense University of Madrid, Madrid, Spain; and Internal Medicine Unit, Clínico San Carlos Hospital, Madrid, Spain (Dr García-Klepzig).

Correspondence: Candelas López-López, PhD, Hospital Universitario 12 de Octubre, UCI de Trauma y Emergencias, Avenida de Córdoba s/n, 28041 Madrid, Spain (

The authors declare no conflicts of interest.

Copyright © 2018 by the Society of Trauma Nurses.