Kiesewetter I, Bartels U, Bauer A, Schneider G, Pilge S
Department of Anaesthesiology, Ludwig-Maximilians-Universität München, Munich, Germany.
Department of Anaesthesiology, Helios Clinic Wuppertal, Witten/Herdecke University, Wuppertal, Germany.
Anaesthesist. 2019 Dec;68(12):836-842. doi: 10.1007/s00101-019-00694-5. Epub 2019 Nov 20.
The implementation of the Critical-Care Pain Observation tool (CPOT) in intensive care units (ICU) has been associated with more frequent pain assessments, a reduced number of complications, and improved administration of analgesics and sedatives. So far no German translation exists. Translating this tool into foreign languages requires further validation testing.
The aim of this prospective observational validation study was to translate the original version of the CPOT according to scientific principles for translation and to establish the validity and reliability of the German translation of CPOT for critically ill adult patients.
A total of 292 cardiac surgery patients from 2 ICUs of 2 German university teaching hospitals were included (114 patients at center 1 and 178 patients at center 2). Of the included patients 22.6% were female and 76.4% were male with a mean age of 68.5 years ±9.3 SD. Pain was evaluated with the CPOT, the Bhavioral Pain Scale (BPS) and with the Numeric Rating scale (NRS) at three time points (1. intubated + sedated, 2. intubated + awake, 3. extubated + awake) at rest and during nociceptive stimulus (positioning). Assessments were made separately by trained physicians and nursing staff.
Good results for interrater reliability and internal consistency could be demonstrated (weighted Cohen's kappa of 0.73, Cronbach's coefficient alpha of 0.8). Spearman correlation between CPOT and NRS was moderate but significant. The receiver operating characteristic (ROC) analysis to obtain optimal thresholds of CPOT to detect pain revealed different results during rest and stimulus and in intubated and extubated patients.
The validated German CPOT translation is a reliable tool for pain assessment in cardiac ICU patients in the absence of patients' ability for self-reporting. The use of this German version of CPOT now allows a better international comparability of corresponding data in future studies.
重症监护病房（ICU）中实施重症监护疼痛观察工具（CPOT）与更频繁的疼痛评估、并发症数量减少以及镇痛药和镇静剂的给药改善有关。到目前为止，尚无德语翻译版本。将该工具翻译成外语需要进一步的验证测试。
这项前瞻性观察性验证研究的目的是根据科学的翻译原则翻译CPOT的原始版本，并确定针对成年重症患者的CPOT德语翻译版本的有效性和可靠性。
纳入了来自德国2所大学教学医院的2个ICU的292例心脏手术患者（中心1有114例患者，中心2有178例患者）。纳入患者中，22.6%为女性，76.4%为男性，平均年龄为68.5岁±9.3标准差。在三个时间点（1.插管+镇静状态、2.插管+清醒状态、3.拔管+清醒状态）的静息和伤害性刺激（体位摆放）期间，使用CPOT、行为疼痛量表（BPS）以及数字评分量表（NRS）对疼痛进行评估。评估由经过培训的医生和护理人员分别进行。
可以证明评分者间信度和内部一致性的结果良好（加权Cohen's kappa为0.73，Cronbach's系数α为0.8）。CPOT与NRS之间的Spearman相关性中等但具有显著性。用于获得检测疼痛的CPOT最佳阈值的受试者工作特征（ROC）分析在静息和刺激期间以及插管和拔管患者中显示出不同结果。
经过验证的CPOT德语翻译版本是在患者无法自我报告的情况下用于心脏ICU患者疼痛评估的可靠工具。现在使用该德语版CPOT可使未来研究中相应数据具有更好的国际可比性。
