Joffe Aaron M, McNulty Bridgett, Boitor Madalina, Marsh Rebekah, Gélinas Céline
University of Washington, Harborview Medical Center, Seattle, WA, USA.
University of Washington, Seattle, WA, USA.
J Crit Care. 2016 Dec;36:76-80. doi: 10.1016/j.jcrc.2016.05.011. Epub 2016 May 25.
Pain is a common symptom in the intensive care unit (ICU). Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioral scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the CPOT use with brain-injured ICU adults.
Eight trained staff nurses and a medical student scored the CPOT before and during a nonpainful (ie, gentle touch) and at least 1 painful (eg, turning) procedure. Then, communicative patients self-reported their pain using yes/no and, when possible, on a 0 to 10 Faces Pain Thermometer.
A total of 79 brain-injured ICU patients participated. The intraclass correlation coefficient between trained raters was 0.73 (95% confidence interval, 0.57-0.83) during turning. CPOT scores were significantly higher during turning compared with gentle touch (P< .001) and correlated significantly with self-reports of pain intensity during turning (0.64, P< .01). The receiver operating characteristics curve indicated a cutoff of 2 with a sensitivity of 0.90 and specificity of 0.67.
Overall, the CPOT use was found to be reliable and valid in this patient group and is new evidence fulfilling an important gap highlighted in the Society of Critical Care Medicine practice guidelines.
疼痛是重症监护病房（ICU）的常见症状。脑损伤患者往往无法可靠地自我报告疼痛，因此需要使用行为量表，如重症监护疼痛观察工具（CPOT）。本研究旨在测试CPOT在成年ICU脑损伤患者中使用的可靠性和有效性。
8名经过培训的护士和1名医学生在进行无痛（即轻柔触摸）和至少1次疼痛（如翻身）操作之前及过程中对CPOT进行评分。然后，能够交流的患者使用“是/否”回答，并在可能的情况下，使用0至10分的面部疼痛温度计自我报告疼痛程度。
共有79名ICU脑损伤患者参与。在翻身过程中，经过培训的评估者之间的组内相关系数为0.73（95%置信区间，0.57 - 0.83）。与轻柔触摸相比，翻身过程中的CPOT评分显著更高（P <.001），且与翻身过程中疼痛强度的自我报告显著相关（0.64，P <.01）。受试者工作特征曲线表明，临界值为2时，敏感性为0.90，特异性为0.67。
总体而言，在该患者群体中发现CPOT的使用是可靠且有效的，这是填补重症医学学会实践指南中突出的重要空白的新证据。
