Reliability and Validity of the Critical-Care Pain Observation Tool: A Rapid Synthesis of Evidence

Abstract

Staff in a tertiary hospital critical care unit in Doha, Qatar, suggested that the Critical-Care Pain Observation Tool (CPOT) would be a better tool for assessing pain in ventilated and sedated patients than current local practice. We undertook a rapid synthesis of evidence to establish whether current research supports use of CPOT for assessing pain in ventilated and sedated patients in a critical care setting. CPOT has been shown in reviews and more recent primary studies to be reliable and valid for most patients unable to self-report in critical care settings. This finding is supported by several guidelines. Studies also suggest that CPOT is feasible for use in research and clinical practice though training of observers is important. Further research may be warranted to strengthen current evidence, particularly in patients with neurological trauma.

Nurses’ Perceived Barriers to and Facilitators of Pain Assessment and Management in Critical Care Patients: A Systematic Review

“… 4 Several nonverbal scales have been approved as valid tools for pain assessment among adult critically ill patients, such as the Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT). 7 However, such tools have been limited by their low specificity and sensitivity for pain indicators, particularly in nonverbal patients, as well as nurses’ misunderstanding, misinterpretation, and underestimation of pain behaviors and nurses’ poor knowledge and attitudes related to the use of such tools. 7 Physiological measures, such as blood pressure, heart rate, and respiratory rate, are sometimes used as alternative pain indicators and can provide important clues for proper pain assessment.…”

“… 7 However, such tools have been limited by their low specificity and sensitivity for pain indicators, particularly in nonverbal patients, as well as nurses’ misunderstanding, misinterpretation, and underestimation of pain behaviors and nurses’ poor knowledge and attitudes related to the use of such tools. 7 Physiological measures, such as blood pressure, heart rate, and respiratory rate, are sometimes used as alternative pain indicators and can provide important clues for proper pain assessment. 8 However, the 2012 Society of Critical Care Medicine (SCCM) guidelines do not recommend the use of these measures alone for pain evaluation in critically ill adult patients; rather, these measures should be used in combination with the evaluation of behavioral indicators of pain.…”

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

“…We assessed pain using the critical care pain observation tool and the numeric rating scale. These methods are validated, sensitive, and reliable methods of assessing pain 16,17 . Education on pain measurement and administration of analgesics was provided to nursing staff during weekly interdepartmental meetings and reinforced during shift changes.…”

Evaluation of Facial Electromyographic Pain Responses in Healthy Participants

“…Of interest to our group now, is the application of this model to a patient cohort during the operative and post-operative periods, i.e. while sedated and therefore unable of self-reporting pain, as recently reviewed [4].…”

“…In addition, the need for more objective pain measures is also driven by a requirement to help patients with conditions that prevents the ability to communicate self-reports. Examples of such cases include sedated patients on ITU or patients with dementia [4,5].…”