Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: a prospective cohort study

Interrater Agreement between Bedside and Video Raters Using the CPOT-Neuro for Pain Assessment in Critically Ill Patients with a Brain Injury

This study aimed to examine the interrater agreement of Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro) scores as a newly developed tool for pain assessment in patients with critical illness and brain injury between raters using two methods of rating (bedside versus video) during standard care procedures (i.e., non-invasive blood pressure and turning). The bedside raters were research staff, and the two video raters had different backgrounds (health and non-health disciplines). Raters received standardized 45 min training by the principal investigator. Video recordings of 56 patient participants with a brain injury at different levels of consciousness were included. Interrater agreement was supported with an Intraclass Correlation Coefficient (ICC) > 0.65 for all pairs of raters and for each procedure. Interrater agreement was highest during turning in the conscious group, with ICCs ranging from 0.79 to 0.90. The use of video recordings was challenging for the observation of some behaviors (i.e., tearing, face flushing), which were influenced by factors such as lighting and the angle of the camera. Ventilator alarms were also challenging to distinguish from other sources for the video rater from a non-health discipline. Following standardized training, video technology was useful in achieving an acceptable interrater agreement of CPOT-Neuro scores between bedside and video raters for research purposes.

Continuous visualization and validation of pain in critically ill patients using artificial intelligence: a retrospective observational study

Machine learning tools have demonstrated viability in visualizing pain accurately using vital sign data; however, it remains uncertain whether incorporating individual patient baselines could enhance accuracy. This study aimed to investigate improving the accuracy by incorporating deviations from baseline patient vital signs and the concurrence of the predicted artificial intelligence values with the probability of critical care pain observation tool (CPOT) ≥ 3 after fentanyl administration. The study included adult patients in intensive care who underwent multiple pain-related assessments. We employed a random forest model, utilizing arterial pressure, heart rate, respiratory rate, gender, age, and Richmond Agitation-Sedation Scale score as explanatory variables. Pain was measured as the probability of CPOT scores of ≥ 3, and subsequently adjusted based on each patient's baseline. The study included 10,299 patients with 117,190 CPOT assessments. Of these, 3.3% had CPOT scores of ≥ 3. The random forest model demonstrated strong accuracy with an area under the receiver operating characteristic curve of 0.903. Patients treated with fentanyl were grouped based on CPOT score improvement. Those with ≥ 1-h of improvement after fentanyl administration had a significantly lower pain index (P = 0.020). Therefore, incorporating deviations from baseline patient vital signs improved the accuracy of pain visualization using machine learning techniques.

Comparison of Pain Score in Patients with Brain Disorders Using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS)

Background: Traumatic brain injury (TBI) is one of the leading causes of death, which ranges from mild and irreversible to severe and life-threatening injuries. Objectives: This study aimed to compare the pain score in patients with brain disorders using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS). Methods: A descriptive comparative study was performed in Ilam province, Iran, in a group of head trauma patients admitted to the intensive care unit who were intubated. One hundred twenty observations of nurses’ practice were performed. A purposive sampling method was utilized. The CPOT and NVPS assessed the pain, and the Glasgow Coma Scale (GCS) assessed the state of consciousness. Data were analyzed by SPSS version 16 software. Results: Patients’ mean ± SD age was 38.45 ± 4.2 years. The mean ± SD pain score on the CPOT before the procedure was 0.39 ± 0.49 in the facial expression dimension, 0.56 ± 0.49 in activity, 0.54 ± 0.50 in muscle tension, and 0.55 ± 0.49 in compatibility with the ventilator. The mean ± SD pain score on the NVPS before the procedure was 0.97 ± 0.20 in facial expression dimension, 0.94 ± 0.49 in activity, 0.95 ± 0.31 in guarding, 0.64 ± 0.49 in vital signs, and 0.92 ± 0.53 in excitement. Conclusions: Both CPOT and NVPS were effective in diagnosing patients’ pain, but the CPOT was more appropriate for diagnosing pain in intubated patients.

Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care: Protocol for a Randomized Crossover Pilot Trial (Preprint)

BACKGROUND

Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice.

OBJECTIVE

The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients.

METHODS

A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients' preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery.

RESULTS

Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited.

CONCLUSIONS

Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40760.

Observation on the Effect of MRI Image Scanning on Knee Pain in Football Injury

To study the effect of football injury on knee pain based on MRI image scanning, in this paper, a total of 31 knee injuries of 29 male professional football players from December 2012 to April 2015 were used as the experimental group. The players were 23.6 ± 3.5 years old and received professional football training time 15.3 ± 3.6 years; 31 outpatients of the same age group with acute knee joint acute injury were randomly selected as the control group; both groups were imaged with a 1.5 TMR scanner and knee joint standard array coil imaging, and 2 senior radiation surgeons evaluate knee cartilage, meniscus, ligaments, tendons, bone marrow, infrapatellar fat pad, and joint effusions. Pearson's chi-squared test and nonparametric test for two independent samples were used for statistical testing of the evaluation results. The experimental results showed that there were significant differences in the incidence of articular cartilage, lateral collateral ligament, tendon or ligament injury, multiligament or tendon injury, and bone marrow edema between the two groups (P < 0.05). There was no significant difference in the incidence of medial collateral ligament injury, infrapatellar fat pad edema, and joint effusion. MRI shows that knee injuries in male professional football players often involve ligaments or tendons, mostly multiligament or tendon injuries. The lesions of articular cartilage and meniscus are more common and serious, and bone marrow edema is also more common in football injuries. MRI has high diagnostic accuracy for various clinical knee injuries, and it belongs to a noninvasive examination method. It can not only reflect the pathological changes and changes of the knee joints of patients but also provide information for the formulation of clinical programs and the judgment of prognosis, for timely, accurate, and comprehensive imaging reference.