• Arch Phys Med Rehabil · Jun 2020

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

    • Nicolas Lejeune, Aurore Thibaut, Géraldine Martens, Charlotte Martial, Sarah Wannez, Steven Laureys, and Camille Chatelle.
    • GIGA-Consciousness, Coma Science Group, University of Liège, Belgium; Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium; Centre Hospitalier Neurologique William Lennox, Groupe Hospitalier Saint-Luc, UCL, Ottignies, Belgium. Electronic address: nicolas.lejeune@uclouvain.be.
    • Arch Phys Med Rehabil. 2020 Jun 1; 101 (6): 1064-1067.

    ObjectiveTo 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).DesignA cohort study in which patients were evaluated at a single time point.SettingPatients were evaluated in a tertiary care hospital.ParticipantsPatients (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.InterventionsNot applicable.Main Outcome MeasuresWe 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.ResultsThe 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%).ConclusionOur 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.Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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