Severgnini Paolo, Pelosi Paolo, Contino Elena, Serafinelli Elisa, Novario Raffaele, Chiaranda Maurizio
Department of Biotechnologies and Sciences of Life, Intensive Care Unit-ASST Sette Laghi-Ospedale di Circolo Fondazione Macchi, University of Insubria, Viale Luigi Borri 57, 21100 Varese, Italy.
Largo R. Benzi 10, 16132 Genova, Italy.
J Intensive Care. 2016 Nov 7;4:68. doi: 10.1186/s40560-016-0192-x. eCollection 2016.
Critically 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.
In 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.
CPOT and BPS showed a good criterion and discriminant validity ( < 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 ( < 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.
In 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.
NCT01669486.
入住重症监护病房（ICU）的重症患者可能会遭受不同的疼痛刺激，但疼痛评估却很困难，因为他们大多数几乎处于镇静状态，无法自我报告。因此，优化这些患者的疼痛评估非常重要。本研究的主要目的是比较两种常用的疼痛评估量表：重症监护疼痛观察工具（CPOT）和行为疼痛量表（BPS），用于评估清醒和昏迷患者的疼痛。次要目的包括：（1）确定护理操作过程中决定疼痛量表变化的最相关参数；（2）将这两种疼痛量表与视觉模拟量表（VAS）进行比较；（3）确定无法沟通的患者疼痛评估的最佳量表组合。
在这项观察性研究中，对101例患者在入住ICU后3天内进行了总共303次连续观察。在清醒（n = 41）和昏迷（n = 60）患者的护理操作前1分钟、操作期间和操作后20分钟，分别使用这两种量表进行测量；此外，仅在清醒患者中尽可能记录VAS。我们计算了两种量表的标准效度和判别效度（Wilcoxon检验、Spearman等级相关系数）。评估了各个量表的准确性。评估了CPOT和BPS评分的敏感性和特异性。使用二次权重的Kappa系数来反映两种量表之间的一致性，并计算效应大小以确定现象的强度。
CPOT和BPS均显示出良好的标准效度和判别效度（P < 0.0001）。发现BPS比CPOT更具特异性（91.7%），但敏感性较低（BPS为62.7%，CPOT为76.5%）。CPOT和BPS评分与VAS显著相关（P < 0.0001）。BPS和CPOT联合使用时敏感性更高，为80.4%。面部表情是决定疼痛量表变化的主要参数，效应大小 = 1.4。
在重症机械通气患者中，CPOT和BPS均可用于评估疼痛强度，但其敏感性和特异性不同。与单独使用量表相比，BPS和CPOT联合使用可能会提高检测疼痛的准确性。
NCT01669486。
