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. 2024 Jan;39(1):12-20.
doi: 10.1177/08850666231187336. Epub 2023 Jul 16.

Correlation of the Critical Care Pain Observation Tool and Numeric Rating Scale in Intensive Care Unit Patients

Joanna L Stollings  1   2 , Kelli A Rumbaugh  1 , Li Wang  3 , Christina J Hayhurst  2   4 , E Wesley Ely  2   5   6   7   8 , Christopher G Hughes  2   4   6   9
Affiliations

Correlation of the Critical Care Pain Observation Tool and Numeric Rating Scale in Intensive Care Unit Patients

Joanna L Stollings et al. J Intensive Care Med. 2024 Jan.

Abstract

Purpose: We sought to determine the correlation between the Numeric Rating Scale (NRS) and Critical-Care Pain Observation Tool (CPOT) to determine whether clinical factors modified the relationship between NRS and CPOT assessments.

Materials and methods: We included nonventilated adults admitted to the MICU or SICU who could self-report pain and had at least 3 paired NRS and CPOT assessments. We performed Spearman correlation to assess overall correlation and performed proportional odds logistic regression to evaluate whether the relationship between NRS and CPOT assessments was modified by clinical factors.

Results: Nursing staff performed NRS and CPOT assessments every 4 h in 1302 patients, leading to 61,142 matched assessments. We found that the NRS and CPOT have a Spearman correlation coefficient of 0.56 and an intraclass correlation coefficient of 0.32 in intensive care unit patients. Factors that modified the relationship between the NRS and CPOT included the presence of delirium (P < .001) and lower mean daily Richmond Agitation Sedation Scale (<0.001).

Conclusions: The correlation coefficient between the NRS and the CPOT was found to be 0.56. The presence of delirium, decreased level of arousal, modified the relationship between the NRS and CPOT. Self-reported and behavioral pain assessments cannot be used interchangeably in critically ill adults.

Keywords: CPOT; NRS; analgesia; pain; sedation.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Ely received honoraria for nonpromotional speaking from Hospira Inc. Dr Ely and Hughes have received research grant from Dr Franz Kohler Chemie GMBH. Dr Hughes is a consultant for Sedana Medical. Keywords: Pain, Critical Care Pain Observation Tool, Numeric Rating Scale. Dr Stollings, Dr Rumbaugh, Ms. Wang, and Dr Hayhurst have nothing to disclose.

Figures

Figure 1.
Figure 1.
Patient flow diagram.
Figure 2.
Figure 2.
The size of the circle indicates relative number of observations, except point (0,0), which has 5.
Figure 3.
Figure 3.
Nonmedication risk factors for modification of the relationship between the CPOT and Numeric Rating Scale (NRS).
Figure 4.
Figure 4.
Medication risk factors for modification of the relationship between the CPOT and Numeric Rating Scale (NRS).
See this image and copyright information in PMC

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