Abstract : Introduction:Pain assessment is associated with important outcomes in ICU patients but remains challenging,particularly in non-communicative patients. Use of a reliable tool is paramount to allow any implementation ofsedation/analgesia protocols in a multidisciplinary team. This study compared psychometric properties (inter-rateragreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale(BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-verbalPain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU.Methods:Pain was assessed by at least one of four investigators and one of the 20 bedside nurses before, duringand 10 minutes after routine care procedures in non-comatose patients (Richmond Agitation Sedation Scale≥−3)who were unable to self-report their pain intensity. The Confusion Assessment Method for the ICU was used toassess delirium. Non-parametric tests were used for statistical analysis. Quantitative data are presented as median(25thto 75th).Results:A total of 258 paired assessments of pain were performed in 30 patients (43% lightly sedated, 57% withdelirium, 63% mechanically ventilated). All three scales demonstrated good psychometric properties. However,BPS and CPOT exhibited the best inter-rater reliability (weighted-κ0.81 for BPS and CPOT) and the best internalconsistency (Cronbach-α0.80 for BPS, 0.81 for CPOT), which were higher than for NVPS (weighted-κ0.71,P<0.05;Cronbach-α0.76,P<0.01). Responsiveness was significantly higher for BPS compared to CPOT and for CPOTcompared to NVPS. For feasibility, BPS was rated as the easiest scale to remember but there was no significantdifference in regards to users’preference.Conclusions:BPS and CPOT demonstrate similar psychometric properties in non-communicative intubated andnon-intubated ICU patients.
