Detecting Pain Correlates With Recovery in Acute Brain Injury Patients With Disorders of Consciousness

Abstract

OBJECTIVES: – To evaluate pain as measured by the critical care pain observation tool (CPOT) and its potential as a biomarker for recovery in acute brain injury (ABI) patients with disorders of consciousness (DoC). DESIGN: – Prospective observational single-center study. SETTING: – Neuroscience ICU 2020–2024. PATIENTS: – ABI patients with DoC. INTERVENTIONS: – None. MEASUREMENTS AND MAIN RESULTS: – Data included demographic, clinical characteristics, and CPOT scores. Glasgow Outcome Scale-Extended (GOSE) was obtained at 3, 6, and 12 months. Descriptive statistics, correlation coefficients, and logistic regression models were calculated to assess relationships between pain and GOSE. Of 110 patients, 62 (56%) had traumatic brain injury, 45 (41%) intracerebral hemorrhage, and 3 (3%) subarachnoid hemorrhage. Average age was 50 ± 18 years old, 76% males, and 69% White. A total of 27 patients (25%) experienced less than 5% of moderate/severe pain burden, 83 (75%) experienced greater than or equal to 5%, 59 (54%) greater than or equal to 10%, 36 (33%) greater than or equal to 15%, and 17 (16%) greater than or equal to 20%. We found on average two to three times higher odds of consciousness recovery (GOSE ≥ 3) and functional recovery (GOSE ≥ 4) at 12 months in patients who experience a higher burden of pain. The association with outcomes remained even after adjusting for age, Glasgow Coma Scale at admission, and sedation levels. Moderate/severe burden levels correlated positively with consciousness recovery (r = 0.23; p < 0.05), functional recovery (r = 0.2; p < 0.05), and the sliding dichotomy of GOSE, tailoring outcomes according to baseline severity (r = 0.43; p < 0.05) at 12-month follow-up and across all time points, whereas no pain levels correlated negatively across outcomes and time points. CONCLUSIONS: – Pain as evaluated by a commonly used score in the ICU (CPOT score) is common and its burden correlated consciousness and functional recovery at 3, 6, and 12 months in ABI patients with DoC.