Abstract
The Critical-Care Pain Observation Tool is a behavioral scale recommended for pain assessment in nonverbal critically ill adults. Although the use of this tool was validated in various critical care patient groups, little is known about its validity of use in seriously ill patients at high risk of dying in the intensive care unit, which is the purpose of this study. A prospective cohort study with repeated-measure within-subject design was conducted in a Canadian intensive care unit. Two trained raters assessed the pain of 22 participants with the Critical-Care Pain Observation Tool before, during, and 15 minutes after a nonnociceptive procedure (gentle touch) and a nociceptive procedure (turning). Interrater reliability and discriminant validation were examined. Intraclass correlation coefficients greater than 0.75 between the raters' scores supported interrater reliability. Higher Critical-Care Pain Observation Tool scores were found during turning compared with gentle touch (P < 0.01), demonstrating discriminant validation. The Critical-Care Pain Observation Tool seems to be valid, can be used consistently, and is able to discriminate painful from nonpainful conditions in the nonverbal critically ill adults at high risk of dying.