Pain assessment with Critical-care pain observation tool (CPOT) in severe brain injury patients: a meta-analysis

doi:10.3877/cma.j.issn.2096-1537.2019.04.009

Abstract

Abstract:

Objective

To evaluate the validity of pain assessment with Critical-care pain observation tool (CPOT) in severe brain injury patients.

Methods

Literatures regarding pain assessment with CPOT in severe brain injury patients were systematically searched through the PubMed and other databases. Studies that met the inclusion and exclusion criteria were identified, quality was assessed and data were extracted by two independent investigators. Statistical analysisincluding meta-analysis of mean difference (MD) and diagnostic studieswere performed withRevMan 5.3 and meta-DiSc software.

Results

A total of 9 published and eligible studies involving 944 cases were included in this meta-analysis. In total of 6 studies, CPOT score had statistical significancein the discriminant validity during non-nociceptive and nociceptive procedure (MD=-2.25, P<0.001). Meanwhile, CPOT had statistical significance before and during nociceptive procedure in total of 8 studies (MD=-2.06, P<0.001). To assess the criterionvalidity of CPOT, with the referencestandard of ″patients′ complaint of pain″ during medical procedures in 4 studies, pooled sensitivity and specificity were 0.739 (95% CI: 0.689-0.785, I²=34.7%) and 0.789 (95% CI: 0.737-0.835, I²=0). The area under AUC curve was 0.831. The heterogeneity analysis of calibration validity showed the existence of threshold effect.

Conclusion

CPOT has a good discriminant validity and criterion validityforpain assessment during nociceptive procedureamong severe brain injury patients. For the criterion validity of CPOT the cut-off value of pain needs further investigation.

Key words: Pain, Assessment, Severe brain injury, Critical care, Critical-care pain observation tool, Meta-analysis

Jingran Chen, Kai Shan, Guangqiang Chen, Ming Xu, hongliang Li, Jianxin Zhou. Pain assessment with Critical-care pain observation tool (CPOT) in severe brain injury patients: a meta-analysis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(04): 338-345.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2019.04.009

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Figures/Tables 9

References 29

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纳入的研究（文献作者，年份）	样本例数	研究设计	参照指标	结论	NOS评分
Lee等，2013^[12]	31例	致痛性操作（吸痰）前、中、20 min后	收入ICU后第1、3、6、9、14 d的CPOT水平	收入ICU后第1天疼痛最剧烈	6
陈晗等，2016^[18]	118例可交流者	致痛性操作（拔出深静脉导管）前、中、20 min后	VAS及主诉疼痛	CPOT对于操作痛的评价具有较好的准确性，而对于昏迷患者疼痛的评价价值还需要进一步研究。	7
Shan等，2018^[19]	214例可交流，186例不可交流者	致痛性操作（吸痰）与非致痛性操作（无创血压）前、时	BIS、生理学指标及主诉疼痛	信度和效度检验支持CPOT在神经重症患者中的应用	6
孟春等，2011^[20]	103例	致痛性操作（翻身加吸痰）前、时于非致痛性操作（静息）时	PIDS评分	CPOT与患者自述疼痛呈中等程度相关，是对神经重症的老年患者进行评价的有效手段	7
Echegragy等，2014^[21]	43例可交流患者	致痛性（翻身）及非致痛性操作（无创血压）前、中、15 min后	患者主诉疼痛	CPOT在神外术后患者的应用可靠而有效	7
Gelinas 2016^[22]（abstract）	54例	致痛性操作（翻身）与非致痛性操作（轻触）中	部分患者主诉疼痛	CPOT修订版在神经重症患者中应用有效，可考虑作为疼痛评价的代替	6
Joffe等，2016^[23]	可交流者28例，不可交流者51例	致痛性（翻身）及非致痛性操作（轻触）前、中	患者主诉疼痛	CPOT对自我报告的疼痛高度敏感，且与自我报告的疼痛呈正相关	6
Topolovec等，2013^[24]	34例可交流者，32例不可交流者	致痛性操作（翻身）及非致痛性操作（无创血压）前、中、20 min后	NVPS-R及患者主诉疼痛	CPOT可应用于神经重症患者	6
Sulla等，2017^[25]	50例，包括可交流与不可交流者	致痛性操作（翻身加吸痰）前、中、20 min后	NRS、PAINAD	意大利版CPOT在神经重症患者应用中可靠且有效	6

纳入的研究（文献作者，年份）	样本例数	研究设计	参照指标	结论	NOS评分
Lee等，2013^[12]	31例	致痛性操作（吸痰）前、中、20 min后	收入ICU后第1、3、6、9、14 d的CPOT水平	收入ICU后第1天疼痛最剧烈	6
陈晗等，2016^[18]	118例可交流者	致痛性操作（拔出深静脉导管）前、中、20 min后	VAS及主诉疼痛	CPOT对于操作痛的评价具有较好的准确性，而对于昏迷患者疼痛的评价价值还需要进一步研究。	7
Shan等，2018^[19]	214例可交流，186例不可交流者	致痛性操作（吸痰）与非致痛性操作（无创血压）前、时	BIS、生理学指标及主诉疼痛	信度和效度检验支持CPOT在神经重症患者中的应用	6
孟春等，2011^[20]	103例	致痛性操作（翻身加吸痰）前、时于非致痛性操作（静息）时	PIDS评分	CPOT与患者自述疼痛呈中等程度相关，是对神经重症的老年患者进行评价的有效手段	7
Echegragy等，2014^[21]	43例可交流患者	致痛性（翻身）及非致痛性操作（无创血压）前、中、15 min后	患者主诉疼痛	CPOT在神外术后患者的应用可靠而有效	7
Gelinas 2016^[22]（abstract）	54例	致痛性操作（翻身）与非致痛性操作（轻触）中	部分患者主诉疼痛	CPOT修订版在神经重症患者中应用有效，可考虑作为疼痛评价的代替	6
Joffe等，2016^[23]	可交流者28例，不可交流者51例	致痛性（翻身）及非致痛性操作（轻触）前、中	患者主诉疼痛	CPOT对自我报告的疼痛高度敏感，且与自我报告的疼痛呈正相关	6
Topolovec等，2013^[24]	34例可交流者，32例不可交流者	致痛性操作（翻身）及非致痛性操作（无创血压）前、中、20 min后	NVPS-R及患者主诉疼痛	CPOT可应用于神经重症患者	6
Sulla等，2017^[25]	50例，包括可交流与不可交流者	致痛性操作（翻身加吸痰）前、中、20 min后	NRS、PAINAD	意大利版CPOT在神经重症患者应用中可靠且有效	6

纳入的研究（文献的第一作者，年份）	患者人数				敏感度（95%可信区间）	特异度（95%可信区间）	AUC	诊断界值
纳入的研究（文献的第一作者，年份）	真阳性	假阳性	假阴性	真阴性	敏感度（95%可信区间）	特异度（95%可信区间）	AUC	诊断界值
陈晗等，2016^[18]	43	10	19	46	0.69（0.56~0.80）	0.82（0.70~0.91）	0.778	1.0
Shan等，2018^[19]	168	42	62	160	0.73（0.67~0.79）	0.79（0.73~0.85）	0.837	2.0
Echogrorgy等，2014^[21]	20	4	6	11	0.77（0.56~0.91）	0.73（0.45~0.93）	0.864	1.5
Joffe等，2016^[23]	24	4	3	7	0.89（0.71~0.98）	0.64（0.31~0.89）	0.722	2.0

纳入的研究（文献的第一作者，年份）	患者人数				敏感度（95%可信区间）	特异度（95%可信区间）	AUC	诊断界值
纳入的研究（文献的第一作者，年份）	真阳性	假阳性	假阴性	真阴性	敏感度（95%可信区间）	特异度（95%可信区间）	AUC	诊断界值
陈晗等，2016^[18]	43	10	19	46	0.69（0.56~0.80）	0.82（0.70~0.91）	0.778	1.0
Shan等，2018^[19]	168	42	62	160	0.73（0.67~0.79）	0.79（0.73~0.85）	0.837	2.0
Echogrorgy等，2014^[21]	20	4	6	11	0.77（0.56~0.91）	0.73（0.45~0.93）	0.864	1.5
Joffe等，2016^[23]	24	4	3	7	0.89（0.71~0.98）	0.64（0.31~0.89）	0.722	2.0

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