Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: a prospective cohort study
Céline Gélinas,
Mélanie Bérubé,
Kathleen A. Puntillo,
Madalina Boitor,
Melissa Richard-Lalonde,
Francis Bernard,
Virginie Williams,
Aaron M. Joffe,
Craig Steiner,
Rebekah Marsh,
Louise Rose,
Craig M. Dale,
Darina M. Tsoller,
Manon Choinière,
David L. Streiner
Affiliations
Céline Gélinas
Ingram School of Nursing, McGill University
Mélanie Bérubé
Faculty of Nursing, Université Laval
Kathleen A. Puntillo
Physiological Nursing, University of California San Francisco
Madalina Boitor
Faculty of Dentistry, McGill University
Melissa Richard-Lalonde
Ingram School of Nursing, McGill University
Francis Bernard
Équipe de Recherche en Soins Intensifs (ERESI), Research centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Coeur-de-Montréal
Virginie Williams
Équipe de Recherche en Soins Intensifs (ERESI), Research centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Coeur-de-Montréal
Aaron M. Joffe
School of Medicine, University of Washington
Craig Steiner
School of Medicine, University of Washington
Rebekah Marsh
Harborview Medical Center, University of Washington Medicine
Louise Rose
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London
Craig M. Dale
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
Darina M. Tsoller
Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, CIUSSS West-Central Montreal
Manon Choinière
Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Succursale Centre-Ville
David L. Streiner
Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph’s Healthcare
Abstract Background 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. Methods 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). Results Higher CPOT-Neuro scores were found during nociceptive procedures compared to rest and non-nociceptive procedures in both data sets (p 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. Conclusions 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.
