Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators.

Celine Gelinas, Celeste Johnson

The objective of this cross-over observational study was to validate the English version of the Critical-Care Pain Observation Tool (CPOT) against physiologic indicators [mean arterial pressure, heart rate, respiratory rate, and transcutaneous oxygen saturation (SpO(2))] in critically ill ventilated adults.  The study aimed to assess the interrater reliability of the CPOT, determine the discriminant validity of the tool for a nociceptive and non-nociceptive procedure and the criterion validity of the tool against the ‘gold-standard’ of self-reported pain.  A total of 30 conscious and 25 unconscious patients (Glasgow coma scale ? 8) were recruited. Patients were assessed before, during, and 20 minutes after two procedures: (1) nociceptive procedure: turning, and (2) non-nociceptive procedure: taking noninvasive blood pressure (NIBP). Conscious ventilated patients provided self-report level of pain. The study demonstrated a high degree of interrater reliability and discriminant validity.  For criterion validity, the CPOT scores were correlated to the patients' self-reports of pain, whereas physiologic measures were not.  The authors concluded that the CPOT is a reliable and valid tool to assess pain in critically ill adults, and that behavioural indicators represent more valid information in pain assessment than physiologic indicators.  Further research is needed to explore how specific critically ill populations (e.g., head injury) react to a painful procedure.

Clinical Journal of Pain, 2007, 23(6), 497-505

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