ArticleCritical care (London, England)2021
Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: a prospective cohort study.
Article in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Pain Measurement in Critically Ill Non-Verbal Patients With Brain Injury: A Systematic Review.Nursing in critical care · 2026Pooled it
- Nociception level index monitoring in intensive care: pain awareness in pressure ulcer care in unconscious patients: a randomized controlled pilot study.Irish journal of medical science · 2025Trial
- Trial
- Early Markers of Systemic Inflammation are not Related to Pain Burden After Aneurysmal Subarachnoid Hemorrhage: A Multicenter Observational Study.Neurocritical care · 2026Observational
- Early Prediction of Delirium in Postcardiac Surgery Patients: Machine Learning Model Development and External Validation.JMIR medical informatics · 2026Article
- Detecting Pain Correlates With Recovery in Acute Brain Injury Patients With Disorders of Consciousness.Critical care explorations · 2025Observational
- Validity and reliability of the Critical-Care Pain Observation Tool (CPOT) for critically ill pediatric patients.PloS one · 2025Observational
- Care of the Patient Nearing the End of Life in the Neurointensive Care Unit.Neurocritical care · 2024Review
- Interrater Agreement between Bedside and Video Raters Using the CPOT-Neuro for Pain Assessment in Critically Ill Patients with a Brain Injury.Nursing reports (Pavia, Italy) · 2024Article
- Evaluating pain in non-verbal critical care patients: a narrative review of the critical care pain observation tool and Its clinical applications.Frontiers in pain research (Lausanne, Switzerland) · 2024Review
- Continuous visualization and validation of pain in critically ill patients using artificial intelligence: a retrospective observational study.Scientific reports · 2023Observational
- Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care Unit: Protocol for a Crossover Pilot Randomized Controlled Trial.JMIR research protocols · 2023Article
Corrections and comments
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Authors and funding
15 authors at 11 institutions in 3 countries.
Funding
Abstract
backgroundPain assessment in brain-injured patients in the intensive care unit (ICU) is challenging and existing scales may not be representative of behavioral reactions expressed by this specific group. This study aimed to validate the French-Canadian and English revised versions of the Critical-Care Pain Observation Tool (CPOT-Neuro) for brain-injured ICU patients.
methodsA prospective cohort study was conducted in three Canadian and one American sites. Patients with a traumatic or a non-traumatic brain injury were assessed with the CPOT-Neuro by trained raters (i.e., research staff and ICU nurses) before, during, and after nociceptive procedures (i.e., turning and other) and non-nociceptive procedures (i.e., non-invasive blood pressure, soft touch). Patients who were conscious and delirium-free were asked to provide their self-report of pain intensity (0-10). A first data set was completed for all participants (n = 226), and a second data set (n = 87) was obtained when a change in the level of consciousness (LOC) was observed after study enrollment. Three LOC groups were included: (a) unconscious (Glasgow Coma Scale or GCS 4-8); (b) altered LOC (GCS 9-12); and (c) conscious (GCS 13-15).
resultsHigher CPOT-Neuro scores were found during nociceptive procedures compared to rest and non-nociceptive procedures in both data sets (p < 0.001). CPOT-Neuro scores were not different across LOC groups. Moderate correlations between CPOT-Neuro and self-reported pain intensity scores were found at rest and during nociceptive procedures (Spearman rho > 0.40 and > 0.60, respectively). CPOT-Neuro cut-off scores ≥ 2 and ≥ 3 were found to adequately classify mild to severe self-reported pain ≥ 1 and moderate to severe self-reported pain ≥ 5, respectively. Interrater reliability of raters' CPOT-Neuro scores was supported with intraclass correlation coefficients > 0.69.
conclusionsThe CPOT-Neuro was found to be valid in this multi-site sample of brain-injured ICU patients at various LOC. Implementation studies are necessary to evaluate the tool's performance in clinical practice.
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