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Use of the critical-care pain observation tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation: A STROBE-compliant observational study.

Abstract The assessment of pain in patients with brain injury is challenging due to impaired ability to communicate. We aimed to test the reliability and validity of the critical-care pain observation tool (CPOT) and the bispectral index (BIS) for pain detection in critically brain-injured patients.This prospective observational study was conducted in a neurosurgical intensive care unit in a University-Affiliated Hospital. Adult brain-injured patients undergoing mechanical ventilation were enrolled. Nociceptive (endotracheal suctioning) and non-nociceptive (gentle touching) procedures were performed in a random crossover fashion. Before and immediately after the procedure, CPOT was evaluated by 2 residents and 2 chief nurses, and BIS was documented. The ability to self-report pain was also assessed. The inter-observer reliability of CPOT was analyzed. The criterion and discriminant validities of the CPOT and the BIS were tested.During the study, we enrolled 400 brain-injured patients. The ability to self-report pain was maintained in 214 (54%) and 218 (55%) patients during suctioning and gentle touching, respectively. The intraclass correlation coefficients (95% confidence interval) for inter-observer reliability of CPOT ranged from 0.86 (0.83-0.89) to 0.93 (0.91-0.94). Using self-reported pain as the reference, the area under the receiver operating characteristic curve (95% confidence interval) was 0.84 (0.80-0.88) for CPOT and 0.76 (0.72-0.81) for BIS. When the 2 instruments were combined as either CPOT ≥2 or BIS ≥88 after the procedure, the sensitivity and specificity were 0.90 (0.85-0.93) and 0.59 (0.52-0.66), respectively; and when the 2 instruments were combined as both CPOT ≥2 and BIS ≥88, the sensitivity and specificity were 0.62 (0.55-0.68) and 0.89 (0.83-0.93). Both CPOT and BIS increased significantly after suctioning (all P < .001) but remained unchanged after gentle touching (P ranging from .06 to .14).Our criterion and discriminant validity results supported the use of CPOT and BIS to detect pain in critically brain-injured patients. Combining use of CPOT and BIS in different ways might provide comprehensive pain assessment for different purposes.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29851854
OWN - NLM
STAT- MEDLINE
DCOM- 20180612
LR  - 20180612
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 22
DP  - 2018 Jun
TI  - Use of the critical-care pain observation tool and the bispectral index for the
      detection of pain in brain-injured patients undergoing mechanical ventilation: A 
      STROBE-compliant observational study.
PG  - e10985
LID - 10.1097/MD.0000000000010985 [doi]
AB  - The assessment of pain in patients with brain injury is challenging due to
      impaired ability to communicate. We aimed to test the reliability and validity of
      the critical-care pain observation tool (CPOT) and the bispectral index (BIS) for
      pain detection in critically brain-injured patients.This prospective
      observational study was conducted in a neurosurgical intensive care unit in a
      University-Affiliated Hospital. Adult brain-injured patients undergoing
      mechanical ventilation were enrolled. Nociceptive (endotracheal suctioning) and
      non-nociceptive (gentle touching) procedures were performed in a random crossover
      fashion. Before and immediately after the procedure, CPOT was evaluated by 2
      residents and 2 chief nurses, and BIS was documented. The ability to self-report 
      pain was also assessed. The inter-observer reliability of CPOT was analyzed. The 
      criterion and discriminant validities of the CPOT and the BIS were tested.During 
      the study, we enrolled 400 brain-injured patients. The ability to self-report
      pain was maintained in 214 (54%) and 218 (55%) patients during suctioning and
      gentle touching, respectively. The intraclass correlation coefficients (95%
      confidence interval) for inter-observer reliability of CPOT ranged from 0.86
      (0.83-0.89) to 0.93 (0.91-0.94). Using self-reported pain as the reference, the
      area under the receiver operating characteristic curve (95% confidence interval) 
      was 0.84 (0.80-0.88) for CPOT and 0.76 (0.72-0.81) for BIS. When the 2
      instruments were combined as either CPOT &gt;/=2 or BIS &gt;/=88 after the procedure,
      the sensitivity and specificity were 0.90 (0.85-0.93) and 0.59 (0.52-0.66),
      respectively; and when the 2 instruments were combined as both CPOT &gt;/=2 and BIS 
      &gt;/=88, the sensitivity and specificity were 0.62 (0.55-0.68) and 0.89
      (0.83-0.93). Both CPOT and BIS increased significantly after suctioning (all P &lt; 
      .001) but remained unchanged after gentle touching (P ranging from .06 to
      .14).Our criterion and discriminant validity results supported the use of CPOT
      and BIS to detect pain in critically brain-injured patients. Combining use of
      CPOT and BIS in different ways might provide comprehensive pain assessment for
      different purposes.
FAU - Shan, Kai
AU  - Shan K
AD  - Emergency Department.
FAU - Cao, Wei
AU  - Cao W
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
FAU - Yuan, Yuan
AU  - Yuan Y
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
FAU - Hao, Jing-Jing
AU  - Hao JJ
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
FAU - Sun, Xiu-Mei
AU  - Sun XM
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
FAU - He, Xuan
AU  - He X
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
FAU - Li, Gui-Yun
AU  - Li GY
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
FAU - Wang, Yu-Mei
AU  - Wang YM
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
FAU - Zhou, Jian-Xin
AU  - Zhou JX
AD  - Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical
      University, Beijing, China.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Brain Injuries/*diagnosis/therapy
MH  - Consciousness Monitors/*statistics &amp; numerical data
MH  - Critical Care/*methods
MH  - Critical Illness
MH  - Cross-Over Studies
MH  - Female
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Observer Variation
MH  - Pain/*diagnosis
MH  - Pain Measurement/*methods
MH  - Prospective Studies
MH  - Reproducibility of Results
MH  - Respiration, Artificial
MH  - Self Report
MH  - Sensitivity and Specificity
EDAT- 2018/06/01 06:00
MHDA- 2018/06/13 06:00
CRDT- 2018/06/01 06:00
PHST- 2018/06/01 06:00 [entrez]
PHST- 2018/06/01 06:00 [pubmed]
PHST- 2018/06/13 06:00 [medline]
AID - 10.1097/MD.0000000000010985 [doi]
AID - 00005792-201806010-00082 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Jun;97(22):e10985. doi: 10.1097/MD.0000000000010985.