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Enferm Intensiva. 2011 Jan-Mar;22(1):3-12. doi: 10.1016/j.enfi.2010.09.005. Epub 2011 Feb 17.

[Validation of the Scale of Behavior Indicators of Pain (ESCID) in critically ill, non-communicative patients under mechanical ventilation: results of the ESCID scale].

[Article in Spanish]

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  • 1Unidad de Cuidados Intensivos Médicos, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.



To determine the reliability and validity of the "Scale of Behavior Indicators of Pain" (Escala de Conductas Indicadoras de Dolor: ESCID) as a tool to assess pain in the critically ill, non-communicative patients with mechanical ventilation.


An observational study of development and validation of this scale as an instrument for pain measurement in ICU patients over 18 years of age, who are uncommunicative and under mechanical ventilation. Their pain was assessed with the Behavioral Pain Scale (BPS) and the ESCID simultaneously, by two independent observers, when the painful maneuvers (PM), secretion aspiration and mobilization, were applied. Measurements were obtained before, during and after the PM. A descriptive analysis of the general characteristics of the population was carried out. The reliability of the ESCID was measured through the internal consistency of each item using Cronbach's alpha. Intraobserver and interobserver concordance was measured with the repeated measurements analysis of variance test. The components of the two pain scales were compared to obtain the change between the results obtained based on time, observer and procedure. The correlation between the scales was measured with the Pearson's correlation.


A total of 480 observations were obtained in 42 patients, 62% were males; age 57.33 ± 16.35 years. The most frequent ICU admission was due to infectious disease (36%) and neurological disease (35%). Glasgow Coma Scale 8.45±1.2 and Richmond Agitation-Sedation Scale -2.55±1.5. Arterial blood pressure, heart rate and respiratory rate remained stable. Cronbach's s Alpha Coefficient for ESCID ranged from 0.70-0.80. There is a good correlation between the ESCID and BPS in the three measurement points in time: Pearson's correlation: before 0.97, during 0.94 and after 0.95.


ESCID is a reliable and valid tool to assess pain in critically ill, non-communicative patients under mechanical ventilation.

Copyright © 2010 Elsevier España, S.L. y SEEIUC. All rights reserved.

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