Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit

Abstract

Many critically ill patients are unable to self-report their pain. In such situations, the use of valid behavioral pain scales is recommended.

Objective: To validate the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery adults in the neurosurgical intensive care unit.

Design: Repeated-measure within subject prospective design.

Settings: Forty-three elective brain surgery patients of a Canadian university hospital participated.

Method: Participants were video recorded and scored with the CPOT before, during and after a non-nociceptive (non-invasive blood pressure using cuff inflation) and a nociceptive (turning) procedure for a total of six assessments. Self-reports of pain were also obtained.

Results: Discriminant validation was supported with higher mean CPOT scores during the nociceptive procedure compared with the non-nociceptive one. More participants reported higher pain intensity during turning compared with cuff inflation. Criterion validation was supported with a moderate positive correlation between self-reports of pain intensity and CPOT scores during turning. Interrater and intrarater reliability of CPOT scores through the viewing of participants' videos by two trained raters was supported with high Intraclass Correlation Coefficients.

Conclusion: The CPOT appears to be valid for the detection of pain in elective brain surgery patients in the neurosurgical intensive care unit.

Keywords: Adult; Behavioral scale; Brain surgery; CPOT; Intensive care unit; Pain assessment.