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Dimensions of Critical Care Nursing:
doi: 10.1097/DCC.0000000000000021

Validation of the Critical-Care Pain Observation Tool in Adult Critically Ill Patients

Buttes, Paul MSN, RN, CNML; Keal, Ginger BSN, RN, CNML; Cronin, Sherill Nones PhD, RN, BC; Stocks, Laurel MSN, APRN, RN, CCNS; Stout, Cheryl MSN, RN, CENP

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Background: Effective management of pain begins with accurate assessment of its presence and severity, which is difficult in critically ill patients. The Critical-Care Pain Observation Tool (CPOT) was developed to evaluate behaviors associated with pain and validated primarily with cardiac surgical patients.

Objective: The purpose of this study was to examine reliability and validity of the CPOT in a general population of adult, critically ill patients.

Methods: Using a sample of 75 patients from critical care units of a community hospital, pain was evaluated at 3 times (prerepositioning, during repositioning, and postrepositioning) by 2 evaluators, using 3 different pain scales: CPOT; Faces, Legs, Activity, Cry, and Consolability (FLACC) scale; and Pain Intensity Numeric Rating Scale.

Results: Results indicated that reliability and validity of the CPOT were acceptable. Interrater reliability was supported by strong intraclass correlations (ranging from 0.74 to 0.91). For criterion-related validity, significant associations were found between CPOT scores and both FLACC (0.87-0.92) and Pain Intensity Numeric Rating Scale (0.50-0.69) scores. Discriminant validity was supported by significantly higher scores during repositioning (mean, 1.85) versus at rest (pre mean, 0.60; post mean, 0.65).

Discussion: The CPOT is an acceptable behavioral pain assessment scale for use in the general critical care patient population and is more appropriate for use with adults than the FLACC.

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