Authors: Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S, Hall JB

Reference: Crit Care. 2014 Jul 25;18(4):R160. [Epub ahead of print]

INTRODUCTION: Pain assessment is associated with important outcomes in ICU patients but remains challenging, particularly in non-communicative patients. Use of a reliable tool is paramount to allow any implementation of sedation/analgesia protocols in a multidisciplinary team. This study compared psychometric properties (inter-rater agreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale (BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-Verbal Pain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU.

METHODS: Pain was assessed by at least one of four investigators and one of the 20 bedside nurses before, during and 10-minutes after routine care procedures in non-comatose patients (Richmond-Agitation-Sedation-Scale >= -3) who were unable to self-report their pain intensity. The Confusion Assessment Method for the ICU was used to assess delirium. Non-parametric tests were used for statistical analysis. Quantitative data are presented as median (25th – 75th).

RESULTS: A total of 258 paired assessments of pain were performed in 30 patients (43% lightly sedated, 57% with delirium, 63% mechanically-ventilated). All three scales demonstrated good psychometric properties. However, BPS and CPOT exhibited the best inter-rater reliability (weighted-kappa 0.81 for BPS and CPOT) and the best internal consistency (Cronbach-alpha 0.80 for BPS, 0.81 for CPOT) which were higher than for NVPS (weighted-kappa 0.71, P

Pubmed ID: 25063269