Can the Nociception Coma Scale-Revised Be Used in Patients With a Tracheostomy?

Area of Science:

• Neurology
• Pain Assessment
• Rehabilitation Medicine

Background:

• Patients with disorders of consciousness (DOC) often require tracheostomy for airway management.
• Accurate pain assessment in DOC patients is crucial for appropriate care and management.
• The Nociception Coma Scale-Revised (NCS-R) is a validated tool for assessing pain in DOC.

Purpose of the Study:

• To investigate the influence of tracheostomy tubes on pain assessment using the Nociception Coma Scale-Revised (NCS-R) in patients with disorders of consciousness (DOC).
• To determine the validity of the NCS-R cutoff score in DOC patients with tracheostomy.

Main Methods:

• A cohort study involving 125 patients with disorders of consciousness (unresponsive wakefulness syndrome, minimally conscious state, emerging from minimally conscious state).
• Patients were evaluated using the NCS-R after noxious stimulation.
• Comparison of NCS-R scores between patients with and without tracheostomy using the Mann-Whitney U test.

Main Results:

• The presence of a tracheostomy was associated with significantly lower verbal subscores (P=.002) and total NCS-R scores (P=.039).
• The NCS-R cutoff score of 2 remained valid for patients with tracheostomy, demonstrating high sensitivity (71.43%) and specificity (89.29%).
• Excluding the verbal subscore maintained high sensitivity (83.2%) and specificity (92.4%) for the cutoff score of 2.

Conclusions:

• The Nociception Coma Scale-Revised (NCS-R) is a valid tool for pain assessment in DOC patients, including those with tracheostomy.
• The presence of a tracheostomy significantly impacts the verbal subscore of the NCS-R.
• Clinicians should acknowledge the influence of tracheostomy on NCS-R scores, particularly the verbal component, during pain assessment in DOC patients.