title: Validation of the critical-care pain observation tool in adult patients.
abstract: BACKGROUND
  Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally.
  
  
  OBJECTIVE
  To validate the Critical-Care Pain Observation Tool.
  
  
  METHODS
  A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation.
  
  
  RESULTS
  The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest.
  
  
  CONCLUSIONS
  The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.
authors.affiliation: School of Nursing, McGill University, Montreal, Quebec.
authors.forename: Céline
authors.initials: C
authors.lastname: Gélinas
authors.forename: Lise
authors.initials: L
authors.lastname: Fillion
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Puntillo
authors.forename: Chantal
authors.initials: C
authors.lastname: Viens
authors.forename: Martine
authors.initials: M
authors.lastname: Fortier
mesh_terms: D006348:Cardiac Surgical Procedures; D003243:Consciousness; D003422:Critical Care / Q000379:methods*; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D011792:Quebec; D015203:Reproducibility of Results; D012650:Self Disclosure; D013997:Time Factors