Investigating the diagnostic value of the pediatric critical care observation tool (P-CPOT) among children hospitalized in the pediatric intensive care unit in 2021- a comparative study

Effective pain management in the pediatric intensive care unit (PICU) relies on valid assessment tools. This study evaluated the Pediatric Critical Care Observation Tool (P-CPOT) for assessing pain in critically ill children. The objective was to determine the discriminant validity of the P-CPOT by comparing pain scores during a nociceptive procedure (suctioning) versus a non-nociceptive procedure (NIBP) and rest, and to establish its criterion validity against the FLACC scale. A cross-sectional study was performed involving fifty children in the PICU of Tehran Children’s Medical Center in 2021. An experienced nurse simultaneously performed pain assessments using the P-CPOT and FLACC tools before, during, and after suctioning, NIBP measurement, and rest. Discriminant validity was assessed by comparing scores across conditions, and criterion validity was evaluated using correlation analysis. Data analysis utilized descriptive and inferential statistics through SPSS software with a significance threshold of P < 0.05. A strong positive correlation was found between P-CPOT and FLACC scores (P < 0.001), confirming criterion validity. Discriminant validity was excellent: P-CPOT scores were significantly higher during the nociceptive procedure compared to both the non-nociceptive procedure (t=-13.208, P < 0.001, d = 1.868). The results also indicated that there is a significant discriminant validity during the nociceptive procedure compared to resting time, with a difference in intensity of 1.86. The P-CPOT demonstrates strong discriminant and confirming criterion validity for pain assessment in the PICU setting. It is a valid tool for distinguishing pain from non-pain states and is highly correlated with an established pain scale, supporting its use for clinical practice in intubated children.