Validation of the Critical Care Pain Observation Tool in XXXX @entity1 With @entity933 : A Prospective Cohort Study.

@entity1 @entity3124 @entity26 @entity2146 @entity158 @entity933
OBJECTIVES: The 2013 clinical practice guidelines for the management of @entity158 , @entity2146 , and @entity933 in adult @entity1 in the ICU suggest that @entity158 be routinely assessed using a validated @entity158 assessment tool. Currently available tools have only been evaluated in nondelirious @entity3124 @entity1 , yet @entity933 can affect as many as 80% of ICU @entity1 . The validated @entity158 assessment tool adopted by our institution is the Critical Care Pain Observation Tool, and the objective of this study was to investigate the validity of this tool in @entity1 with evidence of @entity933 . DESIGN: Prospective cohort study. SETTING: Two ICUs within a Canadian tertiary healthcare center. @entity1 : Forty consecutive adult @entity1 deemed delirious on the day of enrollment using the Confusion Assessment Method for ICU. MEASUREMENTS AND MAIN RESULTS: Serial Critical Care Pain Observation Tool assessments were conducted simultaneously by study personnel and objective nurses at baseline and after nonpainful and @entity158 stimuli. Subjective opinions about @entity158 and objective physical variables (including mean arterial pressure, heart rate, respiratory rate, and @entity26 saturation) were collected at the same time points. Discriminant validity was described using paired t tests, whereas internal consistency was described using the Cronbach a statistic. Responsiveness of the Critical Care Pain Observation Tool was measured by effect size, and reliability was described as the agreement between raters. Comparisons between the Critical Care Pain Observation Tool and the subjective assessments and objective measurements were based on positive and negative percent agreement. Critical Care Pain Observation Tool demonstrated excellent discriminant validity as evidenced by a highly statistically and clinically significant change in mean Critical Care Pain Observation Tool scores between baseline and @entity158 procedures (mean difference, 3.13        1.56; p < 0.001; Cohen D, 2.0). Interrater agreement was also excellent (k > 0.6), and scores between raters were highly correlated (r = 0.957). The Critical Care Pain Observation Tool possessed a high level of internal consistency (overall Cronbach a, 0.778). Percent agreement was found to be greater between the Critical Care Pain Observation Tool and the nurse's subjective opinion of the presence or absence of @entity158 when compared with that between the Critical Care Pain Observation Tool and physiologic variables (80.5% vs 67.5%, respectively). CONCLUSIONS: The Critical Care Pain Observation Tool is a valid @entity158 assessment tool in noncomatose, delirious adult ICU @entity1 who are unable to reliably self-report the presence or absence of @entity158 .
