Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool

Rijkenberg, Saskia; Stilma, Willemke; Endeman, Hendrik; Bosman, R. J.; Straaten, Heleen M. Oudemans–van

doi:10.1016/j.jcrc.2014.09.007

Cited by 92 publications

(128 citation statements)

References 37 publications

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“…Our results are in line with those reported in previous studies showing that both BPS and CPOT increase during nursing care and return back to baseline in a short period of time [27]. The diagnostic performance of both CPOT and BPS worsened after nursing care, suggesting that these scores might be affected by clinical maneuvres.…”

Section: Discussionsupporting

confidence: 92%

“…It is important to note that facial expression is also easier to be scored at bedside. Furthermore, BPS and CPOT showed a good criterion and discriminant validity as previously reported [24–27], but BPS showed higher specificity but lower sensitivity compared to CPOT and so we cannot have considered CPOT superior to BPS, contrary to our hypothesis.…”

Section: Discussionsupporting

confidence: 43%

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

Severgnini

Pelosi²,

Contino

et al. 2016

j intensive care

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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

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 43%

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

Severgnini

Pelosi²,

Contino

et al. 2016

j intensive care

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show abstract

“…A recent study about the validity of the CPOT and BPS showed in a subgroup of seven agitated patients (RASS +1) non-significant increases in CPOT scores between rest and the painful procedure but no difference at all between the non-painful procedure and the painful procedure. The baseline CPOT score in this small subgroup was also higher than patients with RASS < +1 (18). Although this was a very small sample it is a signal that the validity of the CPOT in patients with a hyperactive delirium and/or RASS > +1 requires further investigation.…”

Section: Commentarymentioning

confidence: 69%

Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients?

Rijkenberg

Voort

2016

J. Thorac. Dis.

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“…2 Untreated acute pain in adult ICU patients has short-and longterm physiological and psychological consequences such as postoperative myocardial infarction, insufficient sleep and the risk of developing a post-traumatic stress disorder.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Pain in Ventilated Icu Patie NTS Using Behavioral Pain Scale

Nidhin¹,

Mahmood²,

Padmanabha³

2015

jemds

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Systematic assessment of pain is difficult in intensive care units, because most of the patients are non-communicative and are unable to self-report pain. The Behavioral Pain Scale (BPS) is one of the assessment tools for uncommunicative and sedated intensive care unit patients. This study is to assess and evaluate the efficacy and reliability of BPS scale in mechanically ventilated patients. MATERIALS AND METHODSProspective observational study in 71 mechanically ventilated medical ICU patients who were unable to report pain was assessed with BPS. RESULTSPost procedure there was a significant difference in the percentage of patients with an increased BPS score for repositioning, but not for oral care. CONCLUSIONSThis study showed that the BPS is reliable and valid for use in sedated ICU patients. We conclude that pain scales should be incorporated into pain management as protocols to target the desired levels of analgesia in order to optimize inter-professional practices and to achieve better patient outcomes.

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Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool

Cited by 92 publications

References 37 publications

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

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

Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients?

Assessment of Pain in Ventilated Icu Patie NTS Using Behavioral Pain Scale

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