Highlights
- •The Nociception Coma Scale-Revised (NCS-R) has been developed to assess nociception in patients with disorders of consciousness.
- •Verbal and total scores of the NCS-R are lower in patients with a tracheostomy.
- •Facial and motor subscores do not differ between patients with or without tracheostomy.
- •NCS-R scores should be cautiously interpreted in the presence of tracheostomy.
- •However, our findings support the use of the NCS-R in real clinical practice.
Abstract
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
Patients (N=125) (unresponsive wakefulness syndrome [UWS]: 46 patients, minimally
conscious state [MCS]: 74 patients, emerging from MCS [eMCS]: 5 patients, mean age:
46±16y, time since injury: 817±1280d) 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 Mann-Whitney
U test. A secondary outcome was to evaluate the influence of the presence of a tracheostomy
on the previously described cutoff score of 2.
Results
The presence of a tracheostomy was associated with lower verbal subscores (P=.002) as well as total scores (P=.039). The cutoff 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 patients with a tracheostomy.
However, the presence of a nonspeaking tracheostomy should be clearly mentioned when
applying the NCS-R, because it significantly lowers the verbal subscore.
Keywords
List of abbreviations:
DOC (disorders of consciousness), MCS (minimally conscious state), NCS-R (Nociception Coma Scale Revised), UWS (unresponsive wakefulness syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 22, 2019
Footnotes
Supported by the University and University Hospital of Liege, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Union’s Horizon 2020 Framework Programme for Research and Innovation under the specific Grant No. 785907 (Human Brain Project SGA2), the Luminous project (EU-H2020-fetopenga686764), the Center-TBI project (FP7-HEALTH-602150), the Public Utility Foundation Université Européenne du Travail, Fondazione Europea di Ricerca Biomedica, the Bial Foundation, the European Space Agency, the Mind Science Foundation, and the European Commission. N.L. is a PhD fellow, A.T. is a postdoctoral fellow, and S.L. is research director at FRS-FNRS. C.C. is a Marie Sklodowska-Curie fellow (H2020-MSCA-IF-2016-ADOC-752686).
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
