Reevaluation of the Critical-Care Pain Observation Tool in Intubated Adults After Cardiac Surgery

Abstract

Background Pain assessment in critically ill patients who are intubated, sedated, and unable to verbalize their needs remains a challenge. No universally accepted pain assessment tool is used in all intensive care units. Objectives To examine concurrent validation of scores on the Critical-Care Pain Observation Tool for a painful and a nonpainful procedure and to examine interrater reliability of the scores between 2 nurse raters. Methods A prospective, repeated-measures within-subject design was used. A convenience sample of 35 patients was recruited to achieve enrollment of 30 patients during a 5-month period. Observational data were collected on patients intubated after cardiac surgery during routine turning and during dressing changes for central catheters. Results Raters' mean scores did not increase significantly during dressing changes (increase, +0.25; 95% CI, -0.07 to 0.57; P = .12) but did increase significantly during turning (increase, +3.04; 95% CI 2.11-3.98; P < .001). The degree to which mean scores increased was significantly greater during turning than during dressing changes (increase, +2.80; 95% CI, 1.84-3.75; P < .001). The Fleiss-Cohen weighted κ for the interrater reliability of the ratings of research nurses was 0.87 (95% CI, 0.79-0.94). Conclusion The results support previous research investigations on validity and reliability of the Critical-Care Pain Observation Tool for evaluating pain in intubated, critically ill adults.

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

“…79 A recent validation study 80 in a sample of 30 intubated cardiac surgery patients supports the previous research findings that the CPOT has acceptable interreliability and concurrent validity.…”

Pain Assessment in Noncommunicative Adult Palliative Care Patients

“…Use of the CPOT has had positive effects on nurses’ pain assessment and documentation, and may affect treatment processes, mechanical ventilation time and ICU length of stay 41 , but its effects on patients’ pain outcomes remain to be evaluated. The CPOT’s reliability and validity have been confirmed in several small studies conducted by other investigators 42,43 , although one 42 noted lower inter-rater reliability than initial studies and suggested the use of standardized instructions and training. Others have extended the use of the CPOT to neurological intensive care unit patients who had brain surgery 44 and critically ill patients with delirium 45 , but unfortunately both French and English versions were used and treated as one in the analysis.…”

Intensive care unit patients' experience of being conscious during endotracheal intubation and mechanical ventilation

“…This is consistent with other findings (Gardner et al , ). When patients go through endotracheal intubation, pain management seems extremely important and a reliable observation tool and adequate pain management are crucial (Linde et al , ; Stites, ).…”