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* BACKGROUND Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally.
* OBJECTIVE To validate the Critical-Care Pain Observation Tool.
* METHODS A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient s self-report of pain was obtained while the patient was conscious and intubated and after extubation.
* RESULTS The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted κ coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest.
* CONCLUSIONS The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain. (American Journal of Critical Care. 2006;15:420-427)
Pain is an important stressor for many patients in critical care,1-3 and it is not unusual for the intensity of the pain to be described as moderate to severe.4-12 Pain assessment is the first step in proper pain relief, an important goal in patients' care. Although critical care clinicians strive to obtain each patient's self-report of pain, many factors compromise patients' ability to communicate verbally, including the use of sedative agents, mechanical ventilation, and changes in the level of consciousness.13,14 Several pain scales have been used to document self-reporting of pain in intubated patients.7-9,12 In the absence of a patient's self-report, observable behavioral and physiological indicators become important indices for the assessment of pain.13,15-17
Preliminary research18-20 has...