Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study

Abstract

BackgroundCritically ill patients admitted to intensive care unit (ICU) may suffer from different painful stimuli, but the assessment of pain is difficult because most of them are almost sedated and unable to self-report. Thus, it is important to optimize evaluation of pain in these patients. The main aim of this study was to compare two commonly used scales for pain evaluation: Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS), in both conscious and unconscious patients. Secondary aims were (1) to identifying the most relevant parameters to determine pain scales changes during nursing procedures, (2) to compare both pain scales with visual analog scale (VAS), and (3) to identify the best combination of scales for evaluation of pain in patients unable to communicate.MethodsIn this observational study, 101 patients were evaluated for a total of 303 consecutive observations during 3 days after ICU admission. Measurements with both scales were obtained 1 min before, during, and 20 min after nursing procedures in both conscious (n.41) and unconscious (n.60) patients; furthermore, VAS was recorded when possible in conscious patients only. We calculated criterion and discriminant validity to both scales (Wilcoxon, Spearman rank correlation coefficients). The accuracy of individual scales was evaluated. The sensitivity and the specificity of CPOT and BPS scores were assessed. Kappa coefficients with the quadratic weight were used to reflect agreement between the two scales, and we calculated the effect size to identify the strength of a phenomenon.ResultsCPOT and BPS showed a good criterion and discriminant validity (p < 0.0001). BPS was found to be more specific (91.7 %) than CPOT (70.8 %), but less sensitive (BPS 62.7 %, CPOT 76.5 %). COPT and BPS scores were significantly correlated with VAS (p < 0.0001). The combination of BPS and CPOT resulted in better sensitivity 80.4 %. Facial expression was the main parameter to determine pain scales changes effect size = 1.4.ConclusionsIn critically ill mechanically ventilated patients, both CPOT and BPS can be used for assessment of pain intensity with different sensitivity and specificity. The combination of both BPS and CPOT might result in improved accuracy to detect pain compared to scales alone.Trial registration NCT01669486

Vital signs: Valid indicators to assess pain in intensive care unit patients? An observational, descriptive study

“…When self‐report is impossible, observational pain scales, including the BPS, have been recommended for clinical use for critically ill adults (Hjermstad et al, ; Gélinas, ; Kotfis et al, ; Severgnini et al, ). The BPS takes into consideration three behavioral dimensions: facial expression, movement/positioning of the upper limbs, and compliance with ventilation.…”

“…We analyzed the results according to the presence of pain. Thus, for the NRS and VAS, a score of >1 (Gélinas, ), and a score of >4 for the BPS, were indicative of the presence of pain (Severgnini et al, ).…”

Pain in the ICU; Can We Adequately Treat What We Can’t Hear?

“…Furthermore, the sensitivities and specificities of each scale, along with the sensitivity of the combination of the scales, were reported. 8 The BPS was found to be more specific (91.7%) than CPOT (70.8%) but less sensitive (BPS 62.7%, CPOT 76.5%). Interestingly, the combination of BPS and CPOT resulted in better sensitivity (80.4%) than either scale alone, which suggested that perhaps a combination of both scales may improve accuracy in pain detection.…”

“…As noted in this paper and supported by the literature, pain assessment techniques are imperfect tools and leave room for development of better instruments, especially in the arena of objective assessment of nonverbal individuals. 8 Sadly, many nonverbal patients find communications with nurses to be difficult and unsuccessful. 9 Other areas of concern are the definitions of pain and painful procedures used in this study and similar trials.…”

Metody oceny natężenia bólu u dorosłych pacjentów oddziałów intensywnej terapii —polska wersja językowa narzędzia CPOT (Critical Care Pain Observation Tool) i BPS (Behavioral Pain Scale)

“…A CPOT score of > 2 indicates the presence of pain; the sensitivity of the test is 86% while its specificity is 78% for the assessment of severe post-surgical pain [42,43]. The cut-off value suggested for BPS is >5 [44,45].…”