Sensitivity and Specificity of the Comfort Scale to Assess Pain in Ventilated Critically Ill Adult Patients in Intensive Care Unit

DOI: https://doi.org/10.14710/nmjn.v7i1.15126

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Published: 05-07-2017
Section: Articles
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Background: Pain is a common phenomenon experienced by ventilated and critically ill adult patients. It is urgent to measure the pain among these patients since they are unable to report their pain verbally. Comfort Scale is one of the instruments used to measure pain in adult patients. The scale is used to measure pain among children patients with fairly high sensitivity and specificity.

Purpose: This study aimed to examine the sensitivity and specificity of the Comfort Scale to measure pain in the ventilated critically ill adult patients in the ICU.

Methods: This study employed a cross-sectional design with 66 ventilated adult patients in the ICUs of two hospitals in Semarang. The pain assessment was administered to the patients in 2 duplo periods by two observers comparing with the Comfort Scale and Critical Care Pain Observational Tool (CPOT) as a gold standard instrument during the pre and post positioning procedures. The data were analyzed using the receiver operating curve (ROC).

Result: The results showed that in the pre-positioning procedure, the Comfort Scale had the sensitivity value of 69% and the specificity value of 81%. Meanwhile, in the post-positioning procedure, the values were decreasing (the sensitivity of 45%, the specificity of 67%). This indicated that the sensitivity value of the comfort scale decreased and could be interpreted that the ability of the instrument to detect pain remained low. Meanwhile, the decrease of the specificity value of the instrument between the pre and post administration was not far different, so it could be interpreted that the instrument can correctly identify the patient without pain.

Conclusion: The Comfort Scale had a lower value of sensitivity and specificity in the post-positioning than that in the pre-positioning procedure. It is recommended that further studies should focus on the relationship between sedation and pain by using instruments of pain studies for adult patients (CPOT). Additionally, the hospital policy makers, that is Pain Task Force is expected to give education and training through workshops and seminars about the nurse skills in pain management on critical areas as part of the multidisciplinary team.

Keywords

Comfort scale; sensitivity; specificity

  1. Indah Sri Wahyuningsih 
    Faculty of Nursing, Sultan Agung Islamic University, Semarang, Indonesia
  2. Awal Prasetyo 
    Faculty of Medicine, Diponegoro University, Semarang, Indonesia
  3. Reni Sulung Utami 
    Department of Nursing, Diponegoro University, Semarang, Indonesia
  1. Alderson, S. M., & Mckechnie, S. R. (2013). Unrecognized, undertreated, pain in ICU : causes, effects, and how to do better. Open Journal of Nursing, 3(March 2013), 108–113. doi:10.4236/ojn.2013.31014
  2. Americans Association of Critical -Care Nurses. (2013). Assessing pain in the critically ill adult expected practice and nursing actions. American Association of Critical -Care Nurses, (Level C), 1–7.
  3. Ashkenazy, S., & DeKeyser-Ganz, F. (2011). Assessment of the reliability and validity of the Comfort Scale for adult intensive care patients. Heart & Lung: The Journal of Critical Care, 40(3), e44–51. doi:10.1016/j.hrtlng.2009.12.011
  4. Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gelinas, C., Dasta, J. F., Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: Executive summary. American Journal of Health-System Pharmacy, 70(1), 53–58. doi:10.1097/CCM.0b013e3182783b72
  5. Cade, C. H. (2008). Clinical tools for the assessment of pain in sedated critically ill adults. Nursing in Critical Care, 13(6), 288–297. doi:10.1111/j.1478-5153.2008.00294.x
  6. Dunn, W., & Murphy, J. (2009). Should intensive care medicine itself be on the critical list? Chest, 135(4), 892–894. doi:10.1378/chest.09-0038
  7. Gelinas, C., Arbour, C., Michaud, C., Vaillant, F., & Desjardins, S. (2011). Implementation of the critical-care pain observation tool on pain assessment/management nursing practices in an intensive care unit with nonverbal critically ill adults: a before and after study. International Journal of Nursing Studies, 48(12), 1495–504. doi:10.1016/j.ijnurstu.2011.03.012
  8. Gelinas, C., Echegaray-Benites, C., & Kapoustina, O. (2014). Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive and Critical Care Nursing, 30(5), 257–265. doi:10.1016/j.iccn.2014.04.002
  9. Gelinas, C., Fillion, L., & Puntillo, K. A. (2009). Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. Journal of Advanced Nursing, 65(1), 203–216. doi:10.1111/j.1365-2648.2008.04847.x
  10. Gelinas, Celine, Chanques, Gerald, Puntillo, K. (2014). In pursuit of pain : recent advances and future directions in pain assessment in the ICU. Intensive Care Med, 40(7):1009-14. doi:10.1007/s00134-014-3299-3
  11. Herr, K., Coyne, P. J., Key, T., Manworren, R., McCaffery, M., Merkel, S., … Wild, L. (2006). Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Management Nursing, 7(2), 44–52. doi:10.1016/j.pmn.2006.02.003
  12. Kollef, M. H., Levy, N. T., Ahrens, T. S., Schaiff, R., Prentice, D., & Sherman, G. (1998). The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest, 114(2), 541–548. doi:10.1378/chest.114.2.541
  13. Lellan, K. (2006). Management of pain a practical approach for health care professionals. London: Nelson Thornes Ltd.
  14. Liisa Holsti, P., Ruth E. Grunau, P., Tim F. Oberlander, M., F., and M., & Whitfield, M. (2010). NIH Public Access, 24(4), 303–309. doi:10.1038/ncb1977.Intraflagellar
  15. Manias, E., Botti, M., & Bucknall, T. (2002). Observation of pain assessment and management ) the complexities of clinical practice. J Clin Nurs, 11(6):724-33.724–733.
  16. Payen, J., Bru, O., Bosson, J., & Lagrasta, A. (2001). Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med, 29(12):2258-63.
  17. Payen, J.F., Bosson, J.L., Chanques, G., Mantz, J., & Labarere, J. (2009). Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit. Anesthesiology, 111(6), 1308–1316.
  18. Polit, D. & B. C. (2004). Nursing research: Principles and methods. Philadelphia: Lippincott, Williams& Wilkins.
  19. Stites M. (2008). Clinical tools for the assessment of pain in sedated critically ill adults. Nursing in Critical Care, 13(6).
  20. Subramanian, P., Allcock, N., James, V., & Lathlean, J. (2012). Challenges faced by nurses in managing pain in a critical care setting. Journal of Clinical Nursing, 21(9-10), 1254–1262. doi:10.1111/j.1365-2702.2011.03789.x
  21. Wielenga JM, Rien de Vos, Richard de Leeuw.(2004). Comfort Scale : A reliable and valid method to measure the amount of stress of ventilated preterm infants. Neonatal Netw, 23(2):39-44. doi: 10.1891/0730-0832.23.2.39
  22. Young, J., Siffleet, J., Nikoletti, S., & Shaw, T. (2006). Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive and Critical Care Nursing, 22(1), 32–39. doi:10.1016/j.iccn.2005.04.004