Cheng Li-Hua, Tsai Yun-Fang, Wang Cheng-Hsu, Tsay Pei-Kwei
Department of Nursing, Chang Gung Memorial Hospital at Keelung, 222, Maijin Road, Keelung, 204, Taiwan.
School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Tao-Yuan, 333, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hwa 1st Road, Tao-Yuan, 333, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, 222, Maijin Road, Keelung, 204, Taiwan.
Intensive Crit Care Nurs. 2018 Feb;44:115-122. doi: 10.1016/j.iccn.2017.08.004. Epub 2017 Oct 14.
To compare the construct validities of the Chinese-versions Critical-Care Pain Observation Tool and Behavioural Pain Scale as measures of critically ill patients' pain by (a) discriminant validation of behavioural scales and vital signs (e.g. heart rate and mean arterial pressure) during a non-nociceptive procedure (noninvasive blood pressure] assessment) and a nociceptive procedure (endotracheal suctioning), (b) criterion validation of behavioural scales and vital signs with patients' self-reported pain and (c) testing the interrater reliability of both scores.
RESEARCH METHODOLOGY/DESIGN: In this crossover, observational study, pain responses of 316 critically ill patients (213 conscious; 103 unconscious) were measured by both the Critical Care Pain Observation Tool and the Behavioural Pain Scale scores, vital signs and self-report (if conscious) during noninvasive blood pressure assessment and endotracheal suctioning procedures. Interrater reliability was tested in nociceptive procedures of a pilot study on 20 critically ill patients. Data were analysed by descriptive statistics, multiple logistic regression analysis and receiver-operating characteristic curves.
A medical intensive care unit in a regional teaching hospital in northern Taiwan.
Patients' self-reported pain was predicted by total Critical Care Pain Observation Toolscores (odds ratio=1.93, p<0.01) and total Behavioural Pain scores (odds ratio=1.83, p<0.01) but not by vital signs after controlling for patients' demographic and clinical characteristics. Moreover, Chinese-versions had areas under the receiver-operating characteristic curve of 76.4% and 73.1%, respectively, indicating good ability to detect pain.
The Chinese-versions of the Critical care Pain Observation Toll and Behavioural Pain Score have good construct validity and can sensitively discriminate when critically ill patients experience pain or no pain.
通过以下方式比较中文版危重症疼痛观察工具（Critical-Care Pain Observation Tool）和行为疼痛量表（Behavioural Pain Scale）作为危重症患者疼痛评估工具的结构效度：(a) 在非伤害性操作（无创血压评估）和伤害性操作（气管内吸痰）期间，对行为量表和生命体征（如心率和平均动脉压）进行判别效度验证；(b) 将行为量表和生命体征与患者自我报告的疼痛进行效标效度验证；(c) 检验两种评分的评分者间信度。
研究方法/设计：在这项交叉观察性研究中，在无创血压评估和气管内吸痰操作期间，通过危重症疼痛观察工具和行为疼痛量表评分、生命体征以及自我报告（如果患者清醒）来测量316例危重症患者（213例清醒；103例昏迷）的疼痛反应。在一项针对20例危重症患者的预试验的伤害性操作中检验评分者间信度。数据通过描述性统计、多元逻辑回归分析和受试者工作特征曲线进行分析。
台湾北部一家区域教学医院的医疗重症监护病房。
在控制患者的人口统计学和临床特征后，危重症疼痛观察工具总分（优势比=1.93，p<0.01）和行为疼痛量表总分（优势比=1.83，p<0.01）可预测患者自我报告的疼痛，而生命体征则不能。此外，中文版的受试者工作特征曲线下面积分别为76.4%和73.1%，表明具有良好的疼痛检测能力。
中文版的危重症疼痛观察工具和行为疼痛量表具有良好的结构效度，能够敏感地判别危重症患者是否经历疼痛。
