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Validation of the Critical-Care Pain Observation Tool With Seriously Ill Patients

Ross, Melody MSc(A), BSc(N), RN; Boitor, Madalina PhD(c), BSc(N), RN; Gélinas, Céline PhD, RN

Journal of Hospice & Palliative Nursing: October 2016 - Volume 18 - Issue 5 - p 413–420
doi: 10.1097/NJH.0000000000000266
Feature Articles

The Critical-Care Pain Observation Tool is a behavioral scale recommended for pain assessment in nonverbal critically ill adults. Although the use of this tool was validated in various critical care patient groups, little is known about its validity of use in seriously ill patients at high risk of dying in the intensive care unit, which is the purpose of this study. A prospective cohort study with repeated-measure within-subject design was conducted in a Canadian intensive care unit. Two trained raters assessed the pain of 22 participants with the Critical-Care Pain Observation Tool before, during, and 15 minutes after a nonnociceptive procedure (gentle touch) and a nociceptive procedure (turning). Interrater reliability and discriminant validation were examined. Intraclass correlation coefficients greater than 0.75 between the raters’ scores supported interrater reliability. Higher Critical-Care Pain Observation Tool scores were found during turning compared with gentle touch (P < 0.01), demonstrating discriminant validation. The Critical-Care Pain Observation Tool seems to be valid, can be used consistently, and is able to discriminate painful from nonpainful conditions in the nonverbal critically ill adults at high risk of dying.

Melody Ross, MSc(A), BSc(N), RN, is graduate student, Ingram School of Nursing, McGill University, Montreal, QC, Canada.

Madalina Boitor, PhD(c), BSc(N), RN, is doctoral candidate, Ingram School of Nursing, McGill University, Montreal, QC, Canada.

Céline Gélinas, PhD, RN, is associate professor, Ingram School of Nursing and, McGill University, and Jewish Jewish General Hospital - Centre for Nursing Research, Montreal, QC, Canada.

Address correspondence to Céline Gélinas, PhD, RN, Ingram School of Nursing, McGill University, 3506 University St, Montreal, QC, H3A 2A7 Canada (

This research was partly supported by funding from the Canadian Institutes of Health Research (PHE-122193). The funding agency was not involved in the preparation of the research protocol and in the writing of this article.

The authors have no conflicts of interest to disclose.

© 2016 by The Hospice and Palliative Nurses Association.