Joanna Stollings, PharmD, FCCM
MICU Clinical Pharmacy Specialist
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Disclosure information not submitted.
Kelli Rumbaugh, PharmD, BCPS, BCCCP
Vanderbilt University Medical Center
Nashville
Disclosure information not submitted.
Li Wang, MS
Statistician
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Christina Hayhurst, MD
Anesthesiologist
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Pratik Pandharipande, MD, MSCI
Professor
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Wes Ely, MD, MPH
Professor
Vanderbilt University Medical Center
Nashville, TN, United States
Disclosure information not submitted.
Christopher Hughes, MD, MS
Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Disclosure information not submitted.
Title: Correlation of the Critical Care Pain Observation Tool and Numeric Rating Scale in ICU Patients
Introduction: Many clinicians equate Numeric Rating Scale (NRS) and Critical Care Pain Observation Tool (CPOT) scores when evaluating pain in critically ill patients although the NRS is not observational while the CPOT is. These values have not been shown to be interchangeable, and the correlation between NRS and CPOT values has only been assessed in a small number of patients undergoing procedures. We sought to determine the correlation between NRS and CPOT by clinical staff in a large cohort of medical (MICU) and surgical (SICU) ICU patients and to determine whether clinical factors modified the relationship between NRS and CPOT assessments.
Methods: We included adults admitted to the MICU or SICU at a quaternary academic medical center who could self-report pain and had at least 3 paired (within 60 minutes) NRS and CPOT assessments. We performed Spearman correlation to assess overall correlation and performed proportional odds logistic regression assessing the association of NRS, baseline and time-varying clinical factors, and NRS interaction with clinical factors with CPOT to evaluate whether the relationship between NRS and CPOT assessments was modified by clinical factors.
Results: We included 1,302 patients with 61,142 paired NRS and CPOT assessments. We found that the NRS and CPOT poorly correlated in our cohort (Spearman correlation =0.56). Factors that modified the relationship between the NRS and CPOT included presence of delirium (p< 0.001) and lower mean daily RASS (< 0.001). Medications that modified the relationship between the NRS and CPOT included home use of pregabalin (p=0.017) or oxycodone/acetaminophen (p=0.004) and in hospital use of propofol (p=0.015), iv hydromorphone (p< 0.001), iv fentanyl (p< 0.001), oxycodone (p< 0.001), oxycodone/acetaminophen (p=0.001), and hydrocodone/acetaminophen (p< 0.001).
Conclusions: Correlation between the NRS and the CPOT was found to be poor in a pragmatic setting of a large cohort of MICU and SICU patients. Presence of delirium, lower mean daily RASS, home analgesics, and in hospital sedatives and analgesics modified the relationship between the NRS and CPOT assessments. Self-reported and behavioral pain assessments cannot be used interchangeably in critically ill adults.