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Learning Objective 1: The learner will be able to assess pain on a Dutch intensive care unit using an international recognised pain assessment instrument.
Learning Objective 2: The learner will be able to assess pain on a Dutch intensive care unit when patient communication is problematic.
Pain assessment commonly depends on asking the patient about their perceived pain. In the Intensive Care Unit (ICU) a visual analogue scale (VAS) is used in this way. Patient communication can be problematic on an ICU and the Critical-care pain observational tool (CPOT) was developed to be less dependent on communication with the patient. A validated Dutch version of the CPOT is not available.
Method
A translation into Dutch and a back translation procedure of the English CPOT was done. In 50 patients pain was evaluated using the CPOT and the VAS in 4 situations: before any nursing procedure (pre), during a low nociceptive procedure (face wash), immediately after a nociceptive procedure (turning) and 20 minutes thereafter (post). The CPOT and VAS scores were compared between the 4 situations (paired student t-test). To establish a correlation between a change in CPOT and VAS scores the Pearson’s correlation coefficient was calculated.
Results
The CPOT and VAS scores in the pre and post situation were not different, confirming the unchanged baseline (rest) pain score for these patients. The CPOT score increased during a low nociceptive procedure (p< 0.05), but the VAS score increase was not significant (p= 0.14). Both the CPOT and the VAS scores increased immediately after a nociceptive procedure (p<0.005 for both scores). The correlation coefficient between a change in CPOT and in VAS scores was for the low nociceptive procedure 0.89 (considered very good). The correlation coefficient for the nociceptive procedure was 0.58, (substantial). These coefficients indicate a consistent pattern of significant correlation between CPOT and VAS scores.
Conclusion
The Dutch version of the CPOT is a suitable instrument for assessing pain in the critically ill patients. It has a good correlation with measuring pain with the standard VAS, but is less patient communication dependent.
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