Hoshino Haruhiko, Ikeda Mitsuki, Matsuishi Yujiro, Enomoto Yuki, Shimojo Nobutake, Kotani Misaki, Kobayashi Shunsuke, Kido Takahiro, Hayashi Satomi, Furuya Yoko, Inoue Yoshiaki
Adult Nursing, Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.
Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
PLoS One. 2025 Apr 18;20(4):e0320373. doi: 10.1371/journal.pone.0320373. eCollection 2025.
In some regions, critically ill pediatric and adult patients are cared for in the same intensive care unit, complicating pain assessment due to mixed age groups. To address this, it is essential to use pain scales that are applicable to a wide age range. The Critical-Care Pain Observation Tool (CPOT) was developed to assess pain in both intubated and non-intubated adult patients. However, its applicability in pediatric patients has not been confirmed. The purpose of this study was to evaluate CPOT for critically ill pediatric patients.
We conducted a prospective observational study in an eight-bed open PICU from January 2022 to March 2023. Three research nurses independently assessed pain using CPOT, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, and an Observational Visual Analog Scale (VAS obs). Criterion-related and construct validity were examined using Spearman's rank correlation coefficients between CPOT, VAS obs, and FLACC. Diagnostic performance was evaluated via ROC analysis using a FLACC score ≥ 4 as the reference. CPOT scores with and without medical interventions were compared using the Mann-Whitney U test, and inter-rater reliability was assessed with Cohen's weighted κ.
Ninety-one patients were observed 165 times. CPOT strongly correlated with VAS obs (Spearman's ρ = 0.87, p < 0.01) and FLACC (Spearman's ρ = 0.84, p < 0.01). At a CPOT cut-off score of 3, sensitivity was 100% and specificity was 96.7%. CPOT effectively reflected pain levels during medical interventions (p < 0.01), and inter-rater reliability was high (weighted κ = 0.89, 95% CI: 0.799-0.941).
This study suggests that CPOT may be a useful tool for pain assessment in pediatric patients.
在一些地区，危重症儿童和成人患者在同一重症监护病房接受治疗，由于年龄组混合，使得疼痛评估变得复杂。为解决这一问题，使用适用于广泛年龄范围的疼痛量表至关重要。重症监护疼痛观察工具（CPOT）旨在评估插管和未插管成人患者的疼痛。然而，其在儿科患者中的适用性尚未得到证实。本研究的目的是评估CPOT在危重症儿科患者中的应用。
我们于2022年1月至2023年3月在一间设有8张床位的开放式儿科重症监护病房进行了一项前瞻性观察研究。三名研究护士分别使用CPOT、面部、腿部、活动、哭闹、可安慰性（FLACC）量表和观察视觉模拟量表（VAS obs）评估疼痛。通过CPOT、VAS obs和FLACC之间的Spearman等级相关系数检验与标准相关的效度和结构效度。以FLACC评分≥4作为参考，通过ROC分析评估诊断性能。使用Mann-Whitney U检验比较有无医疗干预时的CPOT评分，并使用Cohen加权κ评估评分者间信度。
共观察了91例患者165次。CPOT与VAS obs（Spearman's ρ = 0.87，p < 0.01）和FLACC（Spearman's ρ = 0.84，p < 0.01）高度相关。CPOT临界值为3分时，敏感性为100%，特异性为96.7%。CPOT有效反映了医疗干预期间的疼痛水平（p < 0.01），评分者间信度较高（加权κ = 0.89，95% CI：0.799 - 0.941）。
本研究表明CPOT可能是评估儿科患者疼痛的有用工具。
