Ge ´rald Chanques Jean-Franc ¸ois Payen Gre ´goire Mercier Sylvie de Lattre Eric Viel Boris Jung Moussa Cisse ´ Jean-Yves Lefrant Samir Jaber Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale Received: 29 April 2009 Accepted: 7 July 2009 Published online: 21 August 2009 Ó Springer-Verlag 2009 Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1590-5) contains supplementary material, which is available to authorized users. G. Chanques ( ) ) Á S. de Lattre Á B. Jung Á M. Cisse ´ Á S. Jaber Service d’Anesthe ´sie et de Re ´animation ‘‘B’’ (SAR B), Intensive Care and Anesthesiology Department, Saint Eloi Hospital-CHU de Montpellier, Montpellier University Hospital, 80, Avenue Augustin Fliche, 34295 Montpellier cedex 5, France e-mail: g-chanques@chu-montpellier.fr Tel.: ?33-467-337271 Fax: ?33-467-337448 J.-F. Payen Intensive Care and Anesthesiology Department, Albert Michallon Hospital, Grenoble University Hospital, BP 217, 38043 Grenoble, France G. Mercier Department of Medical Statistics, Arnaud de Villeneuve Hospital, Montpellier University Hospital, Route de Ganges, 34295 Montpellier cedex 5, France E. Viel Á J.-Y. Lefrant Intensive Care and Anesthesiology Department, Pain Clinic, Care ´meau Hospital, Nı ˆmes University Hospital, Place Professeur Robert Debre ´, 30029 Nı ˆmes cedex 9, France Abstract Purpose: To validate an adaptation of the Behavioral Pain Scale (BPS) for its use in non-intu- bated intensive care unit (ICU) patients unable to self-report their pain because of the occurrence of delirium. The ‘‘vocalization’’ domain was inserted to construct the BPS-non intubated (BPS-NI) scale, ranging from 3 (no pain) to 12 (most pain). Design: Prospective psychometric study in a medical-surgical ICU. Methods: The same physician and one bedside nurse rated pain in non- intubated patients unable to self- report their pain during four condi- tions: before and after a catheter dressing change (non-nociceptive procedure) and before and after turn- ing the patient (nociceptive procedure). Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU). Results: A total of 120 paired evaluations were performed in 30 consecutive adult patients, 84% with delirium (CAM-ICU positive). BPS-NI scores were higher during painful proce- dures than at rest [6.0 (5.0–8.0) vs. 3.0 (3.0–3.8); P \ 0.001], while no changes in BPS-NI scores were found during non-nociceptive procedures (discriminative validity). The BPS-NI had good internal consistency (stan- dardized Cronbach a = 0.79), and each domain reflected the pain expression factor in a balanced way (coefficients between 0.57 and 0.59). The BPS-NI had a good inter-rater reliability (weighted kappa coeffi- cient = 0.89 for the four conditions and 0.82 during nociceptive proce- dures) and a good responsiveness, with an effect size ranging from 1.5 to 3.6. Conclusions: Pain during pro- cedures is perceived even in non-intubated ICU patients with delirium. In those patients, pain level can be assessed with the BPS-NI scale since this instrument exhibited good psychometric properties. Keywords Pain Á Pain measurement Á Analgesia Á Delirium Á Psychomotor agitation Á Intensive care Á Critical care Intensive Care Med (2009) 35:2060–2067 DOI 10.1007/s00134-009-1590-5 ORIGINAL