Ingram School of Nursing, McGill University, 680 Sherbrooke West St., Suite 1800, Montreal, QC, H3A 2M7, Canada.
Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Côte-Sainte-Catherine Road, Montreal, QC, H3T 1E2, Canada.
Crit Care. 2021 Apr 13;25(1):142. doi: 10.1186/s13054-021-03561-1.
Pain assessment in brain-injured patients in the intensive care unit (ICU) is challenging and existing scales may not be representative of behavioral reactions expressed by this specific group. This study aimed to validate the French-Canadian and English revised versions of the Critical-Care Pain Observation Tool (CPOT-Neuro) for brain-injured ICU patients.
A prospective cohort study was conducted in three Canadian and one American sites. Patients with a traumatic or a non-traumatic brain injury were assessed with the CPOT-Neuro by trained raters (i.e., research staff and ICU nurses) before, during, and after nociceptive procedures (i.e., turning and other) and non-nociceptive procedures (i.e., non-invasive blood pressure, soft touch). Patients who were conscious and delirium-free were asked to provide their self-report of pain intensity (0-10). A first data set was completed for all participants (n = 226), and a second data set (n = 87) was obtained when a change in the level of consciousness (LOC) was observed after study enrollment. Three LOC groups were included: (a) unconscious (Glasgow Coma Scale or GCS 4-8); (b) altered LOC (GCS 9-12); and (c) conscious (GCS 13-15).
Higher CPOT-Neuro scores were found during nociceptive procedures compared to rest and non-nociceptive procedures in both data sets (p < 0.001). CPOT-Neuro scores were not different across LOC groups. Moderate correlations between CPOT-Neuro and self-reported pain intensity scores were found at rest and during nociceptive procedures (Spearman rho > 0.40 and > 0.60, respectively). CPOT-Neuro cut-off scores ≥ 2 and ≥ 3 were found to adequately classify mild to severe self-reported pain ≥ 1 and moderate to severe self-reported pain ≥ 5, respectively. Interrater reliability of raters' CPOT-Neuro scores was supported with intraclass correlation coefficients > 0.69.
The CPOT-Neuro was found to be valid in this multi-site sample of brain-injured ICU patients at various LOC. Implementation studies are necessary to evaluate the tool's performance in clinical practice.
在重症监护病房（ICU）中评估脑损伤患者的疼痛具有挑战性，现有的评估量表可能无法代表该特定人群的行为反应。本研究旨在验证法加英修订版重症监护疼痛观察工具（CPOT-Neuro）在脑损伤 ICU 患者中的适用性。
在三个加拿大和一个美国的研究地点进行了一项前瞻性队列研究。研究人员使用 CPOT-Neuro 对创伤性或非创伤性脑损伤患者进行评估，在进行有创（如翻身等）和非有创（如无创血压、轻柔触摸）操作前后及操作期间对患者进行评估。意识清醒且无谵妄的患者被要求对疼痛强度（0-10 分）进行自我报告。所有参与者（n=226）均完成了一组数据，在研究入组后观察到意识水平（LOC）发生变化时，获得了第二组数据（n=87）。包括三组 LOC：（a）无意识（格拉斯哥昏迷量表或 GCS 4-8 分）；（b）意识改变（GCS 9-12 分）；（c）意识清醒（GCS 13-15 分）。
在两组数据中，CPOT-Neuro 评分在有创操作时均高于休息和非有创操作时（p<0.001）。CPOT-Neuro 评分在 LOC 各组间无差异。CPOT-Neuro 评分与休息和有创操作时的自我报告疼痛强度评分呈中度相关（Spearman rho>0.40 和>0.60）。CPOT-Neuro 评分的截断值≥2 和≥3 分别可适度区分自我报告的轻度至重度疼痛≥1 和中度至重度疼痛≥5。观察者间 CPOT-Neuro 评分的可靠性得到了组内相关系数>0.69 的支持。
CPOT-Neuro 在该多中心脑损伤 ICU 患者样本中，在不同 LOC 下具有有效性。需要进行实施研究来评估该工具在临床实践中的性能。
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