Can the Nociception Coma Scale-Revised Be Used in Patients With a Tracheostomy?
(2020) Archives of Physical Medicine and Rehabilitation — Vol. 101, n° 6, p. 1064-1067 (2020)
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- Objective: To investigate the influence of the presence of a tracheostomy tube to assess pain with the Nociception Coma Scale – Revised (NCS-R) in patients with disorders of consciousness (DOC). Design : A cohort study in which patients were evaluated at a single time point. Setting : Patients were evaluated in a tertiary care hospital. Participants: 125 patients (Unresponsive Wakefulness Syndrome (UWS): 46 patients, Minimally Conscious State (MCS): 74 patients, Emerging from MCS: 5 patients; mean age: 46 years +/- 16; time since injury: 817 days +/- 1280) in a convenience sample, were evaluated with the NCS-R after noxious stimulation. Interventions : Not applicable. Main Outcome Measures : We compared the NCS-R scores of patients with and without tracheostomy with a U Mann-Whitney test. A secondary outcome was to evaluate the influence of the presence of a tracheostomy on the previously described cut-off score of 2. Results: The presence of a tracheostomy was associated with lower verbal subscores (p=0.002) as well as total scores (p=0.039). The cut-off score of 2 remained valid for the group of patients with tracheostomy with a high sensitivity (71.43%) and specificity (89.29%), as well as when we excluded the verbal subscore of the NCS-R (Sensitivity=83,2% and Specificity=92,4%.) Conclusion: Our study confirms the validity of the NCS-R in DOC 21 patients with a tracheostomy. However, the presence of a non-speaking tracheostomy should be clearly mentioned when applying the NCS-R, as it significantly lowers the verbal subscore.
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Lejeune, N., Thibaut, A., Martens, G., Martial, C., Wannez, S., Laureys, S., & Chatelle, C. (2020). Can the Nociception Coma Scale-Revised Be Used in Patients With a Tracheostomy? Archives of Physical Medicine and Rehabilitation, 101(6), 1064-1067. https://doi.org/10.1016/j.apmr.2019.09.020 (Original work published 2020)