Pain Assessment Using the Critical-Care Pain Observation Tool in Chinese Critically Ill Ventilated Adults

Context. The psychometric properties of the Critical- Care Pain Observation Tool (CPOT) need to be tested in general intensive care unit patient populations in China. Objectives. To further evaluate the psychometric properties of the CPOT and provide a pain assessment method for Chinese critically ill ventilated adults by validating a translation of the CPOT. Methods. A total of 63 conscious ventilated Chinese adults were repeatedly assessed by two independent raters using the CPOT at rest as well as before and during the two procedures: 1) nociceptive procedure (turning) and 2) non-nociceptive procedure (taking noninvasive blood pressure). A total of 12 assessments were included. Results. The principal component factor analysis revealed that the domain structure of the CPOT was acceptable. Cronbach's alpha coefficient as a measure for the internal consistency ranged from 0.57 to 0.86; intraclass correlation coefficients as a measure for inter- rater reliability ranged from 0.80 to 0.91; Spearman nonparametric coefficients as a measure for test- retest reliability ranged from 0.81 to 0.93. The CPOT total score was significantly higher during the nociceptive procedure, indicating that its discriminant validity was good. Self-reported pain was obtained as the gold standard; the receiver operating characteristic curve analysis determined the best cutoff value of the CPOT (>2) with the specificity (73.3-81.8%) and sensitivity (80.8-89.4%) as well as the area under the curve (range 0.849-0.902). Conclusion. The CPOT has good psychometric properties and can be used as a reliable and valid instrument for pain assessment in Chinese critically ill ventilated adults. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.