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The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries

Gélinas, Célinea,*; Puntillo, Kathleen A.b; Levin, Pavelc; Azoulay, Elied

doi: 10.1097/j.pain.0000000000000834
Research Paper
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Many critically ill adults are unable to communicate their pain through self-report. The study purpose was to validate the use of the 8-item Behavior Pain Assessment Tool (BPAT) in patients hospitalized in 192 intensive care units from 28 countries. A total of 4812 procedures in 3851 patients were included in data analysis. Patients were assessed with the BPAT before and during procedures by 2 different raters (mostly nurses and physicians). Those who were able to self-report were asked to rate their pain intensity and pain distress on 0 to 10 numeric rating scales. Interrater reliability of behavioral observations was supported by moderate (0.43-0.60) to excellent (>0.60) kappa coefficients. Mixed effects multilevel logistic regression models showed that most behaviors were more likely to be present during the procedure than before and in less sedated patients, demonstrating discriminant validation of the tool use. Regarding criterion validation, moderate positive correlations were found during procedures between the mean BPAT scores and the mean pain intensity (r = 0.54) and pain distress (r = 0.49) scores (P < 0.001). Regression models showed that all behaviors were significant predictors of pain intensity and pain distress, accounting for 35% and 29% of their total variance, respectively. A BPAT cut-point score >3.5 could classify patients with or without severe levels (≥8) of pain intensity and distress with sensitivity and specificity findings ranging from 61.8% to 75.1%. The BPAT was found to be reliable and valid. Its feasibility for use in practice and the effect of its clinical implementation on patient pain and intensive care unit outcomes need further research.

The new Behavioral Pain Assessment Tool use has shown good reliability and validity for the assessment of pain in ICU patients in 28 countries.Supplemental Digital Content is Available in the Text.

aIngram School of Nursing, Faculty of Medicine, McGill University, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada

bSchool of Nursing, Department of Physiological Nursing, University of California San Francisco (UCSF), San Francisco, CA, USA

cCentre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada

dMedical Intensive Care Unit, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Université Paris-Diderot, Paris, France

Corresponding author. Address: Ingram School of Nursing, Faculty of Medicine, McGill University, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada. Tel.: 514-398-6157 or 514-340-8222 ext 4645; fax: 514-340-7592. E-mail address: celine.gelinas@mcgill.ca (C. Gélinas).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received April 29, 2016

Received in revised form October 06, 2016

Accepted October 27, 2016

© 2017 International Association for the Study of Pain
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