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Validity and reliability of the Critical-Care Pain Observation Tool (CPOT) for critically ill pediatric patients
Haruhiko Hoshino1, Mitsuki Ikeda2, Yujiro Matsuishi3
1Adult Nursing, Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.
Insights
The Critical-Care Pain Observation Tool (CPOT) shows promise for assessing pain in critically ill pediatric patients. This validated tool demonstrated strong correlation with other scales and high reliability in a PICU setting.
Area of Science:
- Pediatric Intensive Care
- Pain Management
- Clinical Assessment Tools
Background:
- Mixed-age ICUs pose challenges for pain assessment.
- The Critical-Care Pain Observation Tool (CPOT) is validated for adults but not pediatric patients.
- Need for a reliable pain scale for critically ill children.
Purpose of the Study:
- Evaluate the Critical-Care Pain Observation Tool (CPOT) for pain assessment in critically ill pediatric patients.
- Determine CPOT's validity and reliability in a pediatric intensive care unit (PICU).
Main Methods:
- Prospective observational study in an open PICU (Jan 2022-Mar 2023).
- Independent pain assessments using CPOT, FLACC, and VAS obs by three nurses.
- Validity assessed via Spearman correlations; diagnostic performance via ROC analysis; reliability via Cohen's kappa.
Main Results:
- CPOT strongly correlated with VAS obs (ρ=0.87) and FLACC (ρ=0.84) (p<0.01).
- CPOT demonstrated high sensitivity (100%) and specificity (96.7%) at a cut-off score of 3.
- High inter-rater reliability (weighted κ=0.89) and effectiveness during interventions (p<0.01).
Conclusions:
- The Critical-Care Pain Observation Tool (CPOT) is a potentially valuable tool for pediatric pain assessment.
- CPOT offers a reliable and valid method for evaluating pain in critically ill children.
- Findings support CPOT's use in mixed-age ICUs.
Introduction:
In some regions, critically ill pediatric and adult patients are cared for in the same intensive care unit, complicating pain assessment due to mixed age groups. To address this, it is essential to use pain scales that are applicable to a wide age range. The Critical-Care Pain Observation Tool (CPOT) was developed to assess pain in both intubated and non-intubated adult patients. However, its applicability in pediatric patients has not been confirmed. The purpose of this study was to evaluate CPOT for critically ill pediatric patients.
Methods:
We conducted a prospective observational study in an eight-bed open PICU from January 2022 to March 2023. Three research nurses independently assessed pain using CPOT, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, and an Observational Visual Analog Scale (VAS obs). Criterion-related and construct validity were examined using Spearman's rank correlation coefficients between CPOT, VAS obs, and FLACC. Diagnostic performance was evaluated via ROC analysis using a FLACC score ≥ 4 as the reference. CPOT scores with and without medical interventions were compared using the Mann-Whitney U test, and inter-rater reliability was assessed with Cohen's weighted κ.
Results:
Ninety-one patients were observed 165 times. CPOT strongly correlated with VAS obs (Spearman's ρ = 0.87, p < 0.01) and FLACC (Spearman's ρ = 0.84, p < 0.01). At a CPOT cut-off score of 3, sensitivity was 100% and specificity was 96.7%. CPOT effectively reflected pain levels during medical interventions (p < 0.01), and inter-rater reliability was high (weighted κ = 0.89, 95% CI: 0.799-0.941).
Conclusions:
This study suggests that CPOT may be a useful tool for pain assessment in pediatric patients.
