title: Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool.
abstract: OBJECTIVE
  The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for uncommunicative and sedated intensive care unit (ICU) patients. This study compares the discriminant validation and reliability of the CPOT and the BPS, simultaneously, in mechanically ventilated patients on a mixed-adult ICU.
  
  
  METHODS
  This is a prospective observational cohort study in 68 mechanically ventilated medical ICU patients who were unable to report pain.
  
  
  RESULTS
  The BPS and CPOT scores showed a significant increase of 2 points between rest and the painful procedure (turning). The median BPS scores between rest and the nonpainful procedure (oral care) showed a significant increase of 1 point, whereas the median CPOT score remained unchanged. The interrater reliability of the BPS and CPOT scores showed a fair to good agreement (0.74 and 0.75, respectively).
  
  
  CONCLUSIONS
  This study showed that the BPS and the CPOT are reliable and valid for use in a daily clinical setting. Although both scores increased with a presumed painful stimulus, the discriminant validation of the BPS use was less supported because it increased during a nonpainful stimulus. The CPOT appears preferable in this particular group of patients, especially with regard to its discriminant validation.
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Electronic address: saskia_rijkenberg@hotmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Rijkenberg
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Stilma
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Endeman
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Bosman
authors.affiliation: Department of Intensive Care Medicine, Free University Medical Centre, Amsterdam, the Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Oudemans-van Straaten
mesh_terms: D000328:Adult; D001519:Behavior; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial
keywords: BPS; CPOT; Critical illness; Intensive care; Mechanical ventilation; Pain assessment