How Well Do Intensive Care Teams Assess Pain? Prospective Evaluation of the Correlation between Pain Assessments by the Health Professionals and a Validated Scale

Abstract

Objective: To determine the daily agreement between bedside pain assessments made by physicians, nurses and physiotherapists with the Critical Care Observation Tool (CPOT) in critically ill patients.

Methods: Prospective, observational, cohort study in a general ICU in Brazil. 101 patients were included, who were followed for a maximum of 5 days. The patient's pain levels were accessed with CPOT and compared with the evaluation of the health team in a 11-point numerical rating scale.

Results: The overall perception of pain by the health team correlated significantly and weakly with CPOT (Physician: r0.33 95% CI 0.23 - 0.42; p < 0.001); Nurses r0.33 95% CI 0.23 - 0.43 p < 0.001; Physiotherapist r0.33 95% CI 0.23 - 0.43 p < 0.001). Physiotherapists suffered less daily variation in correlation with CPOT, in contrast to physicians and nurses. Health team assessments tended to agree with the CPOT when pain was absent, however a wide variability occurred when pain was present.

Conclusions: There is a lack of agreement between CPOT and health team assessments, and between interprofessional assessments in the presence of pain.

Funding Information: The clinical study received no funding to be performed. The work of BBA is supported by the intramural research program of the Oswaldo Cruz Foundation. BBA is a senior scientist from the Brazilian National Council for Scientific and Technological Development (CNPq).

Declaration of Interests: The authors declare that they have no competing interests.

Ethics Approval Statement: This research was approved by the Research Ethics Committee of the Federal University of Bahia under the number 2.249.687 and CAAE 73835317.5.0000.5577 and was conducted in compliance with the Helsinki declaration. All patients, or their family members, when necessary, provided written consent.

Keywords: pain, Critical Care, Pain Management, Critical-Care Pain Observation Tool