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ISSN: 1734-1922
Archives of Medical Science
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vol. 14
Clinical research

Validation of the Polish version of the Critical Care Pain Observation Tool (CPOT) to assess pain intensity in adult, intubated intensive care unit patients: the POL-CPOT study

Katarzyna Kotfis, Małgorzata Zegan-Barańska, Marta Strzelbicka, Krzysztof Safranow, Maciej Żukowski, E. Wesley Ely

Arch Med Sci 2018; 14, 4: 880–889
Online publish date: 2017/09/01
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Pain in the critically ill affects nearly 50% of patients. In patients unable to self-report pain, behavioural scales are used. The aim of this study was to validate the Polish version of the Critical Care Pain Observation Tool (CPOT).

Material and methods
The prospective observational cohort study included patients observed during non-nociceptive and nociceptive procedures, at rest, during the intervention, and 15 min after each intervention. Assessments included self-report by patients and CPOT assessment carried out by two blinded observers.

A total of 71 patients were included in the study (mean age: 66 years), predominantly males (50/71, 70%), mean APACHE II score 26.04 ±10.56. Results showed an excellent inter-rater correlation (ICC) between raters (ICC scores > 0.97). Self-report NRS (numeric rating scale) scores were available from 58/71 patients (82%). Patients’ self-reported pain and CPOT showed a very strong correlation (Spearman’s R > 0.85, p < 0.0001). The CPOT has high diagnostic value for detection of presence of patients’ self-reported pain (ROC AUC = 0.938 for rater A and 0.951 for rater B, p < 0.0001). CPOT score ≥ 2 is an optimal cut-off to detect pain during a nociceptive procedure. A significantly higher mean CPOT score during a nociceptive procedure as compared to a non-nociceptive procedure or at rest was found (p < 0.0001).

This study shows that the Polish version of the CPOT can be used to assess pain in critically ill patients with no hypnotic, opioid-based analgo-sedation. Polish CPOT scores correlated well with patients’ self-reported presence of pain and showed excellent inter-rater reliability. This makes the Polish version of the CPOT a reliable pain assessment tool.


pain, intensive care, pain intensity, Critical Care Pain Observation Tool, pain measurement tool

Chanques G, Sebbane M, Barbotte E, Viel E, Eledjam JJ, Jaber S. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology 2007; 107: 858-60.
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41: 263-306.
DAS-Taskforce 2015, Baron R, Binder A, Biniek R, Braune S, Buerkle H. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version. Ger Med Sci 2015; 13: Doc19. doi: 10.3205/000223.
Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med 2016; 42: 962-71.
Gelinas C, Fillion L, Puntillo KA, et al. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care 2006; 15: 420-7.
Payen JF, Bru O, Bosson JL, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29: 2258-63.
Kotfis K, Zegan-Barańska M, Szydłowski Ł, Żukowski M, Ely WE. Methods of pain assessment in adult intensive care unit patients – Polish version of the CPOT (Critical Care Pain Observation Tool) and BPS (Behavioral Pain Scale). Anaesthesiol Intensive Ther 2017; 49: 66-72.
Frandsen JB, O’Reilly Poulsen KS, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand 2016; 60: 1314-22.
Li Q, Wan X, Gu C, et al. Pain assessment using the critical-care pain observation tool in Chinese critically ill ventilated adults. J Pain Symptom Manage 2014; 48: 975-82.
Hsiung NH, Yang Y, Lee MS, Dalal K, Smith GD. Translation, adaptation, and validation of the behavioral pain scale and the critical-care pain observational tools in Taiwan. J Pain Res 2016; 9: 661-9.
Gélinas C, Puntillo KA, Joffe AM, Barr J. A validated approach to evaluating psychometric properties of pain assessment tools for use in nonverbal critically ill adults. Semin Respir Crit Care Med 2013; 34: 153-68.
Nürnberg Damström D, Saboonchi F, Sackey PV, Björling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand 2011; 55: 379-86.
Rijkenberg S, Stilma W, Endeman H, Bosman RJ. Oudemans-van Straaten HM. Pain measurement in mechanically ventilated critically ill patients: behavioral Pain Scale versus Critical-Care Pain Observation Tool. J Crit Care 2015; 30: 167-72.
Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the critical-care pain observation tool and physiologic indicators. Clin J Pain 2007; 23: 497-505.
Gelinas C, Fillion L, Puntillo KA. Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. J Adv Nurs 2009; 65: 203-16.
Boitor M, Fiola JL, Gelinas C. Validation of the Critical-Care Pain Observation Tool and vital signs in relation to the sensory and affective components of pain during mediastinal tube removal in postoperative cardiac surgery intensive care unit adults. J Cardiovasc Nurs 2016; 31: 425-32.
Vazquez M, Pardavila MI, Lucia M, Aguado Y, Margall MA, Asiain MC. Pain assessment in turning procedures for patients with invasive mechanical ventilation. Nurs Crit Care 2011; 16: 178-85.
Gelinas C, Harel F, Fillion L, Puntillo KA, Johnston CC. Sensitivity and specificity of the critical-care pain observation tool for the detection of pain in intubated adults after cardiac surgery. J Pain Symptom Manage 2009; 37: 58-67.
Kwak EM, Oh H. Validation of a Korean translated version of the critical care pain observation tool (CPOT) for ICU patients [Korean with English abstract]. J Korean Acad Nurs 2012; 42: 76-84.
Juarez P, Bach A, Baker M, et al. Comparison of two pain scales for the assessment of pain in the ventilated adult patient. Dimens Crit Care Nurs 2010; 29: 307-15.
Golicki D, Niewada M. EQ-5D-5L Polish population norms. Arch Med Sci 2017; 13: 191-200.
Mędrzycka-Dąbrowska W, Dąbrowski S, Basiński A, Pilch D. Perception of barriers to postoperative pain management in elderly patients in Polish hospitals with and without a “Hospital Without Pain” Certificate – a multi-center study. Arch Med Sci 2016; 12: 808-18.
Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S, Hall JB. Psychometric comparison of three behaveoural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care 2014; 18: R160.
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