The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries

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The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries
Key Take-Away: 

A new pain assessment tool, 8-item Behavior Pain Assessment Tool (BPAT) can be a reliable and valid option for hospitalized patients.

Pain assessment is a vast term encompassing clinical judgment based on observation of the type, significance and context of a person’s pain experience.

ABSTRACT: 
Background: 

Pain assessment is a vast term encompassing clinical judgment based on observation of the type, significance and context of a person’s pain experience.

Pain assessment in patients is a critical task due to poor communication abilities of patients. Many critically ill adults are unable to self-report their pain. The present study validated the use of the 8-item BPAT in patients hospitalized in 192 intensive care units from 28 countries.

Methods: 

A total of 4812 procedures in 3851 patients were included in data analysis. Patients were assessed with the BPAT before and during procedures by two different raters (mostly nurses and physicians).

Those who were able to self-report were asked to rate their pain intensity and pain distress on 0 to 10 numeric rating scales. Interrater reliability of behavioral observations was supported by moderate (0.43-0.60) to excellent (>0.60) kappa coefficients. Mixed-effects multilevel logistic regression models showed that most behaviors were more likely to be present during the procedure than before and in less sedated patients, demonstrating discriminant validation of the tool use.

Results: 

Regarding criterion validation, moderate positive correlations were found during the procedures between the mean BPAT scores and the mean pain intensity (r=0.54) and pain distress (r=0.49) scores (p<0.001).

All behaviors were significant predictors of pain intensity and pain distress, accounting for 35% and 29% of their total variance, respectively. A BPAT cut-point score >3.5 could classify patients with or without severe levels (≥8) of pain intensity and distress with sensitivity and specificity findings ranging from 61.8% to 75.1%.

Conclusion: 

The BPAT was found to be the reliable and valid approach to CLBP management.

However, its feasibility in day-to-day practice and the effect of its clinical implementation on the pain and intensive care unit outcomes need further research.

Source:

The Journal of the International Association for the Study of Pain

Link to the source:

http://journals.lww.com/pain/Fulltext/2017/05000/The_Behavior_Pain_Assessment_Tool_for_critically.8.aspx

The original title of the article:

The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries

Authors:

Gélinas, Céline, et al.

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