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 kappa 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.

译文

背景:很少进行研究来验证重症监护中的疼痛评估工具,特别是对于无法通过口头交流的患者。
目的:验证重症患者疼痛观察工具。
方法:在加拿大魁北克市心脏病健康中心招募的重症监护病房中共有105名心脏外科手术患者参加了这项研究。手术后,对105例中有33例进行了无意识和气管插管评估,有99例进行了有意识和气管插管评估。拔管后对所有105例进行评估。对于这三个测试阶段中的每个阶段,均在休息,伤害性手术(定位)期间以及手术后20分钟使用静息疼痛疼痛观察工具对患者进行评估,共进行9次评估。在患者清醒并插管时和拔管后,获得每个患者的自我疼痛报告。
结果:重症监护疼痛观察工具的可靠性和有效性是可以接受的。 Interrater的可靠性由中等到较高的加权Kappa系数提供支持。对于标准有效性,在患者的自我疼痛报告与重症监护疼痛观察工具的评分之间发现显着关联。定位(伤害性操作)与静止时的较高分数可支持判别有效性。
结论:重症监护疼痛观察工具显示,无论危重患者的意识水平如何,重症成年患者都会通过表达可能与疼痛相关的不同行为来对有害刺激做出反应。因此,该工具可用于评估各种疼痛控制措施的效果。

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