A Comparison of Pain Scales in Patients with Disorders of Consciousness Following Craniotomy
Suwannee Suraseranivongse MD*, Pensook Yuvapoositanont BN**, Paphatsorn Srisakkrapikoop BN**, Ruetaichanok Pommul BN**, Waraporn Phaka BN**, Parunut Itthimathin MD***
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Keywords : Craniotomy, Pain, Postoperative, Pain scales, Validity
