title: Validation of the Critical-Care Pain Observation Tool in brain-injured critically ill adults.
abstract: Pain is a common symptom in the intensive care unit (ICU). Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioral scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the CPOT use with brain-injured ICU adults.
  
  
  
  Eight trained staff nurses and a medical student scored the CPOT before and during a nonpainful (ie, gentle touch) and at least 1 painful (eg, turning) procedure. Then, communicative patients self-reported their pain using yes/no and, when possible, on a 0 to 10 Faces Pain Thermometer.
  
  
  
  A total of 79 brain-injured ICU patients participated. The intraclass correlation coefficient between trained raters was 0.73 (95% confidence interval, 0.57-0.83) during turning. CPOT scores were significantly higher during turning compared with gentle touch (P< .001) and correlated significantly with self-reports of pain intensity during turning (0.64, P< .01). The receiver operating characteristics curve indicated a cutoff of 2 with a sensitivity of 0.90 and specificity of 0.67.
  
  
  
  Overall, the CPOT use was found to be reliable and valid in this patient group and is new evidence fulfilling an important gap highlighted in the Society of Critical Care Medicine practice guidelines.
authors.affiliation: University of Washington, Harborview Medical Center, Seattle, WA, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Joffe
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Bridgett
authors.initials: B
authors.lastname: McNulty
authors.affiliation: McGill University, Ingram School of Nursing, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Madalina
authors.initials: M
authors.lastname: Boitor
authors.affiliation: University of Washington, Harborview Medical Center, Seattle, WA, USA.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Marsh
authors.affiliation: McGill University, Ingram School of Nursing, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada. Electronic address: celine.gelinas@mcgill.ca.
authors.forename: Céline
authors.initials: C
authors.lastname: Gélinas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000451:nursing*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000451:nursing; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000451:nursing; D010147:Pain Measurement / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D057566:Self Report; D012680:Sensitivity and Specificity; D020521:Stroke / Q000451:nursing*; D055815:Young Adult
keywords: Behavioral rating scale; Brain injury; Intensive care unit; Pain measurement; Validation study