Original Article
Sensitivity and Specificity of the Critical-Care Pain Observation Tool for the Detection of Pain in Intubated Adults After Cardiac Surgery

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Abstract

A repeated measure design was used to evaluate additional psychometric qualities (sensitivity and specificity) of the Critical-Care Pain Observation Tool (CPOT), a previously validated tool, in intubated intensive care unit (ICU) adults after cardiac surgery recruited in a university cardiology health center in Canada. Patients were evaluated while conscious and intubated (n = 99/105), and extubated (n = 105). For each of these two testing periods, patients were evaluated using the CPOT at rest (pre-exposure), during a nociceptive procedure-turning (exposure), and 20 minutes after the procedure (postexposure). The patients' self-reports of pain were obtained while intubated and extubated. During the nociceptive exposure, the CPOT had a sensitivity of 86%, a specificity of 78%, a positive likelihood ratio (LR+) of 3.87 (1.63–9.23), and a negative LR (LR) of 0.18 (0.09–0.33) and was effective for the screening of pain. It also showed good specificity (83% and 97%) but lower sensitivity (47% and 63%) during nonexposure conditions. The CPOT cutoff score was >2 during the nociceptive exposure. After extubation, patients' self-reports of pain intensity were associated with the positive CPOT cutoff score previously determined. The CPOT adequately classified most of the patients with severe pain. The CPOT seems to be a useful tool to detect pain in intubated postoperative ICU adults, especially during a nociceptive procedure. Sensitivity and specificity of the CPOT need to be further explored during other nociceptive procedures and with different critically ill populations.

Key Words

Pain assessment
sensitivity
specificity
cardiac surgery
critically ill adult

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This work was supported by a Postdoctoral Fellowship from the Fonds de recherche en santé du Québec and the Fondation de recherche en sciences infirmières du Québec.