重症成人使用标准化伤害性刺激验证两种疼痛评估工具。

Validation of Two Pain Assessment Tools Using a Standardized Nociceptive Stimulation in Critically Ill Adults.

机构信息

Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil; Post Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain & Neuromodulation, HCPA/UFRGS, Porto Alegre, Brazil.

Post Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain & Neuromodulation, HCPA/UFRGS, Porto Alegre, Brazil.

出版信息

J Pain Symptom Manage. 2018 Oct;56(4):594-601. doi: 10.1016/j.jpainsymman.2018.06.014.

DOI:10.1016/j.jpainsymman.2018.06.014

PMID:30009967

Abstract

CONTEXT

The Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) are recommended in practice guidelines for pain assessment in critically ill adults unable to self-report. However, their use in another language requires cultural adaptation and validation testing.

OBJECTIVES

Cross-cultural adaptation of the CPOT and BPS English versions into Brazilian Portuguese, and their validation by comparing behavioral scores during rest, standardized nociceptive stimulation by pressure algometry (SNSPA), and turning were completed. In addition, we explored clinical variables that could predict the CPOT and BPS scores.

METHODS

A prospective cohort study was conducted with 168 medical-surgical critically ill adults unable to self-report in the intensive care unit. Two nurses were trained to use the CPOT and BPS Brazilian Portuguese versions at the following assessments: 1) baseline at rest, 2) after SNSPA with a pressure of 14 kgf/cm, 3) during turning, and 4) 15 minutes after turning.

RESULTS

Inter-rater reliability of nurses' CPOT and BPS scores was supported by high weighted kappa >0.7. Discriminative validation was supported with higher CPOT and BPS scores during SNSPA or turning in comparison to baseline (P < 0.001). The Glasgow Coma Scale score was the only variable that predicted CPOT and BPS scores with explained variance of 44.5% and 55.2%, respectively.

CONCLUSION

The use of the Brazilian CPOT and BPS versions showed good reliability and validity in critically ill adults unable to self-report. A standardized procedure, the SNSPA, was used for the first time in the validation process of these tools and helped us improve the validation process.

摘要

背景

行为疼痛量表（BPS）或重症监护疼痛观察工具（CPOT）被推荐用于无法自我报告的重症成人疼痛评估的实践指南。然而，在另一种语言中使用它们需要进行文化适应性调整和验证测试。

目的

将 CPOT 和 BPS 的英文版本进行跨文化适应性调整为巴西葡萄牙语，并通过比较休息、压力测痛标准化伤害性刺激（SNSPA）和翻身期间的行为评分来验证其有效性。此外，我们还探讨了可能预测 CPOT 和 BPS 评分的临床变量。

方法

对 168 名无法在重症监护病房自我报告的内科-外科重症成人进行前瞻性队列研究。两名护士接受了使用 CPOT 和 BPS 巴西葡萄牙语版本的培训，在以下评估中使用：1）休息时的基线，2）SNSPA 压力为 14 kgf/cm 时，3）翻身时，4）翻身后 15 分钟。

结果

护士 CPOT 和 BPS 评分的组内一致性得到高度加权 Kappa 值>0.7 的支持。在 SNSPA 或翻身期间的 CPOT 和 BPS 评分高于基线（P<0.001）支持了区分性验证。格拉斯哥昏迷量表评分是唯一可以预测 CPOT 和 BPS 评分的变量，分别解释了 44.5%和 55.2%的方差。