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Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery
Mandy M J Li1, Don Daniel Ocay1,2, Cynthia L Larche1
1Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.
Insights
The Critical-Care Pain Observation Tool (CPOT) effectively detects postoperative pain in children undergoing spinal fusion surgery. This validated tool aids in accurate pain assessment for pediatric patients, improving care.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Outcomes
Background:
- Accurate postoperative pain measurement in children with intellectual and developmental disabilities is challenging, leading to underrecognition.
- The Critical-Care Pain Observation Tool (CPOT) is validated for adults but its use in pediatric populations requires further investigation.
Purpose of the Study:
- To validate the Critical-Care Pain Observation Tool (CPOT) for pediatric patients capable of self-reporting pain.
- To assess CPOT's utility in children undergoing posterior spinal fusion surgery.
Main Methods:
- A within-subject study involving 24 pediatric patients (10-18 years) undergoing posterior spinal fusion.
- Collected CPOT scores and self-reported pain intensity during nonnociceptive and nociceptive procedures.
- Assessed interrater and intrarater reliability using video recordings of patient behavior.
Main Results:
- CPOT scores were higher during nociceptive procedures, supporting discriminative validation.
- A moderate positive correlation was found between CPOT scores and self-reported pain, supporting criterion validation.
- A CPOT cutoff score of ≥2 demonstrated high specificity (94.1%) and sensitivity (61.3%).
Conclusions:
- The CPOT shows promise as a valid tool for detecting postoperative pain in pediatric patients.
- Findings support CPOT's use in acute inpatient care units for children after posterior spinal fusion.
- This tool can aid in more accurate pain assessment and management for pediatric surgical patients.
Background:
Postoperative pain cannot be measured accurately among many children with intellectual and developmental disabilities, resulting in underrecognition or delay in recognition of pain. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool that has been widely validated in critically ill and postoperative adults.
Aims:
The objective of this study was to validate the CPOT for use with pediatric patients able to self-report and undergoing posterior spinal fusion surgery.
Methods:
Twenty-four patients (10-18 years old) scheduled to undergo surgery were consented to this repeated-measure, within-subject study. To examine discriminative and criterion validation, CPOT scores and patients' self-reports of pain intensity were collected prospectively by a bedside rater before, during, and after a nonnociceptive and nociceptive procedure on the day following surgery. Patients' behavioral reactions were video recorded at the bedside and retrospectively viewed by two independent video raters to examine interrater and intrarater reliability of CPOT scores.
Results:
Discriminative validation was supported with higher CPOT scores during the nociceptive procedure than during the nonnociceptive procedure. Criterion validation was supported with a moderate positive correlation between the CPOT scores and the patients' self-reported pain intensity during the nociceptive procedure. A CPOT cutoff score of ≥2 was associated with the maximum sensitivity (61.3%) and specificity (94.1%). Reliability analyses revealed poor to moderate agreement between bedside and video raters and moderate to excellent consistency within video raters.
Conclusions:
These findings suggest that the CPOT may be a valid tool to detect pain in pediatric patients in the acute postoperative inpatient care unit after posterior spinal fusion.
