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Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study.

ABSTRACT: BACKGROUND:Critically ill patients admitted to intensive care unit (ICU) may suffer from different painful stimuli, but the assessment of pain is difficult because most of them are almost sedated and unable to self-report. Thus, it is important to optimize evaluation of pain in these patients. The main aim of this study was to compare two commonly used scales for pain evaluation: Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS), in both conscious and unconscious patients. Secondary aims were (1) to identifying the most relevant parameters to determine pain scales changes during nursing procedures, (2) to compare both pain scales with visual analog scale (VAS), and (3) to identify the best combination of scales for evaluation of pain in patients unable to communicate. METHODS:In this observational study, 101 patients were evaluated for a total of 303 consecutive observations during 3 days after ICU admission. Measurements with both scales were obtained 1 min before, during, and 20 min after nursing procedures in both conscious (n.41) and unconscious (n.60) patients; furthermore, VAS was recorded when possible in conscious patients only. We calculated criterion and discriminant validity to both scales (Wilcoxon, Spearman rank correlation coefficients). The accuracy of individual scales was evaluated. The sensitivity and the specificity of CPOT and BPS scores were assessed. Kappa coefficients with the quadratic weight were used to reflect agreement between the two scales, and we calculated the effect size to identify the strength of a phenomenon. RESULTS:CPOT and BPS showed a good criterion and discriminant validity (p?

SUBMITTER: Severgnini P

PROVIDER: S-EPMC5100216 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study.

Severgnini Paolo P Pelosi Paolo P Contino Elena E Serafinelli Elisa E Novario Raffaele R Chiaranda Maurizio M

Journal of intensive care 20161107

<h4>Background</h4>Critically ill patients admitted to intensive care unit (ICU) may suffer from different painful stimuli, but the assessment of pain is difficult because most of them are almost sedated and unable to self-report. Thus, it is important to optimize evaluation of pain in these patients. The main aim of this study was to compare two commonly used scales for pain evaluation: Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS), in both conscious and unconscious ...[more]

PMID: 27833752

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Project description:Background:Executive control, the ability to regulate the execution of a goal-directed task, is an important element in an athlete's skill set. Although previous studies have shown that executive control in athletes is better than that in non-athletes, those studies were mainly confined to conscious executive control. Many recent studies have suggested that executive control can be triggered by the presentation of visual stimuli without participant's conscious awareness. However, few studies have examined unconscious executive control in sports. Thus, the present study investigated whether, similar to conscious executive control, unconscious executive control in table tennis athletes is superior to that in non-athletes. Methods:In total, 42 age-matched undergraduate students were recruited for this study; 22 nonathletic students lacking practical athletic experience comprised one group, and 20 table tennis athletes with many years of training in this sport comprised a second group. Each participant first completed an unconscious response priming task, the unconscious processing of visual-spatial information, and then completed a conscious version of this same response priming task. Results:Table tennis athletes showed a significant response priming effect, whereas non-athletes did not, when participants were unable to consciously perceive the visual-spatial priming stimuli. In addition, the number of years the table tennis athletes had trained in this sport (a measure of their motor expertise) was positively correlated with the strength of the unconscious response priming effect. However, both table tennis athletes and non-athletes showed a response priming effect when the primes were unmasked and the participants were able to consciously perceive the visual-spatial priming stimuli. Conclusion:Our results suggest that motor expertise modulates unconscious, rather than conscious, executive control and that motor expertise is positively correlated with unconscious executive control in table tennis athletes.

Project description:ObjectivesSeveral inflammation markers have been reported to be associated with unfavorable clinical outcomes in critically ill patients. We aimed to elucidate whether serum interleukin-6 concentration considered with Sequential Organ Failure Assessment score can better predict mortality in critically ill patients.DesignA prospective observational study.SettingFive university hospitals in 2016-2018.PatientsCritically ill adult patients who met greater than or equal to two systemic inflammatory response syndrome criteria at admission were included, and those who died or were discharged within 48 hours were excluded.InterventionsInflammatory biomarkers including interleukin (interleukin)-6, -8, and -10; tumor necrosis factor-α; C-reactive protein; and procalcitonin were blindly measured daily for 3 days. Area under the receiver operating characteristic curve for Sequential Organ Failure Assessment score at day 2 according to 28-day mortality was calculated as baseline. Combination models of Sequential Organ Failure Assessment score and additional biomarkers were developed using logistic regression, and area under the receiver operating characteristic curve calculated in each model was compared with the baseline.Measurements and main resultsAmong 161 patients included in the study, 18 (11.2%) did not survive at day 28. Univariate analysis for each biomarker identified that the interleukin-6 (days 1-3), interleukin-8 (days 0-3), and interleukin-10 (days 1-3) were higher in nonsurvivors than in survivors. Analyses of 28-day mortality prediction by a single biomarker showed interleukin-6, -8, and -10 at days 1-3 had a significant discrimination power, and the interleukin-6 at day 3 had the highest area under the receiver operating characteristic curve (0.766 [0.656-0.876]). The baseline area under the receiver operating characteristic curve for Sequential Organ Failure Assessment score predicting 28-day mortality was 0.776 (0.672-0.880). The combination model using additional interleukin-6 at day 3 had higher area under the receiver operating characteristic curve than baseline (area under the receiver operating characteristic curve = 0.844, area under the receiver operating characteristic curve improvement = 0.068 [0.002-0.133]), whereas other biomarkers did not improve accuracy in predicting 28-day mortality.ConclusionsAccuracy for 28-day mortality prediction was improved by adding serum interleukin-6 concentration to Sequential Organ Failure Assessment score.

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Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study.

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Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study.

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