Validation of Nonverbal Pain Assessment Tools in Brain-Injured Patients

Purpose : This study aimed to evaluate the reliability and validity of three nonverbal pain assessment tools—Checklist of Nonverbal Pain Indicators (CNPI), Pain Assessment in Advanced Dementia (PAINAD), and Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro)—in brain-injured patients. Methods : This exploratory study included 70 patients with brain injury from a university hospital in Busan and assessed the validity, sensitivity, specificity, and inter-rater reliability of three pain assessment tools. Results : Criterion validity was supported by significant correlations with the Behavioral Pain Scale (BPS) (rs=.47∼.96 for CNPI, rs=.66∼.97 for PAINAD, rs=.80∼.97 for CPOT-Neuro, p ＜.001). Significant differences in pain scores were observed across all three tools before, during, and 20 minutes after suctioning, position changes, and noninvasive blood pressure measurements (p ＜.001). The sensitivity, specificity, and accuracy of each tool were evaluated using receiver operating characteristic (ROC) curve analysis. At moderate pain levels, all three tools showed good overall accuracy, with areas under the ROC (AUROC) ranging from .80 to .90. Inter-rater reliability was high, with intraclass correlation coefficient (ICC) values exceeding .90 for all tools. Conclusion : All three tools effectively assessed nonverbal pain in brain-injured patients. Among them, CPOT-Neuro demonstrated particularly strong validity and reliability, indicating its suitability for clinical use. Further research is needed to identify the optimal tool according to patient characteristics and clinical context.