Escalas para a avaliação da dor na unidade de terapia intensiva. Revisão sistemática

Hora, Tássia Catiuscia Nascimento Silva da; Alves, Iura Gonzalez Nogueira

doi:10.5935/2595-0118.20200043

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Brasil

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Sumário

ARTIGO DE REVISÃO • BrJP 3 (3) • Jul-Sep 2020 • https://doi.org/10.5935/2595-0118.20200043 copiar

Escalas para a avaliação da dor na unidade de terapia intensiva. Revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

JUSTIFICATIVA E OBJETIVOS:

A dor é considerada como uma experiência sensorial e emocional desagradável, associada a uma lesão efetiva ou potencial dos tecidos. Avaliar a dor é muito complexo, principalmente quando se trata de pacientes ventilados mecanicamente na unidade de terapia intensiva. No entanto, existem diversas escalas para avaliam a dor desses pacientes. Dessa forma, este estudo teve como objetivo sumarizar dados acerca das características psicométricas das escalas de avaliação de dor na unidade de terapia intensiva.

CONTEÚDO:

Foi realizada uma revisão sistemática através da pesquisa nas bases de dados Pubmed, LILACS, Cochrane Library e SciELO, foram incluídos os estudos que verificaram a confiabilidade, a validade, reprodutibilidade e a capacidade de resposta das escalas de avaliação de dor na unidade de terapia intensiva. Dos 58 estudos incluídos, o alfa de Cronbach variou de 0,31 a 0,96 e o coeficiente de correlação intraclasse variou de 0,25 a 1,00. Houve adaptação transcultural de 28 estudos nas versões brasileira, chinesa, italiana, sueca, portuguesa, inglesa, holandesa, turca, persa, dinamarquesa, polonesa, espanhola e grega.

CONCLUSÃO:

Os estudos publicados até o momento demonstraram uma lacuna para indicar a superioridade entre as escalas que avaliam dor em pacientes em ventilação mecânica. No Brasil, a maior parte dos estudos ressaltou que as escalas de avaliação da dor apresentam índices de validade, confiabilidade e reprodutibilidade satisfatórios. Assim, a decisão entre a escala a ser utilizada deve considerar facilidade de aplicação e a familiaridade da equipe.

Descritores:
Cuidados críticos; Medição da dor; Reprodutibilidade dos testes; Unidade de terapia intensiva

Autores	País	Pacientes	Amostra	Escalas
Hylén et al.³³33 Hylén M, Alm-Roijer C, Idvall E, Akerman E. To assess patients pain in intensive care: developing and testing the Swedish version of the Behavioural Pain Scale. Intensive Crit Care Nurs. 2019;52:28-34.	Suécia	Adultos	n=57 (63% homens e 37% mulheres)	BPS
Kaya e Erden²⁶26 Kaya P, Erden S. Cross-cultural adaptation, validity and reliability of the Turkish version of revised nonverbal pain scale. Agri. 2019;31(1):15-22.	Turquia	Adultos	n=74	NVPS
Sulla et al.¹⁴14 Sulla F, La Chimia M, Barbieri L, Gigantiello A, Iraci C, Virgili G, et al. A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients. Acta Biomed. 2018;89(7-S):19-24.	Itália	Crianças	n=09	BPS
Klein et al.³⁴34 Klein C, Caumo W, Gélinas C, Patines V, Pilger T, Lopes A, et al. Validation of two pain assessment tools using a standardized nociceptive stimulation in critically ill adults. J Pain Symptom Manage. 2018;56(4):594-601.	Brasil	Adultos	n=168 (88 homens e 80 mulheres)	BPS - CPOT
Pudas-Tähkä e Salanterä³⁰30 Pudas-Tahka S, Salantera S. Reliability of three linguistically and culturally validated pain assessment tools for sedated ICU patients by ICU nurses in Finland. Scand J Pain. 2018;18(2):165-73.	Finlândia	Adultos	n=06 (04 homens e 02 mulheres)	BPS - CPOT - NVPS
Fagioli et al.³⁵35 Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ràva L, et al. Pain assessment in pediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People. 2018;30(5):27-33.	Itália	Crianças	n=35 (17 meninos e 18 meninas)	COMFORT
Shan et al.³⁶36 Shan K, Cao W, Yuan Y, Hao JJ, Sun XM, He X, et al. Use of the critical-care pain observation tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation. A STROBE-compliant observational study. Medicine. 2018;97(22):e10985.	China	Adultos	n=400 (235 homens e 165 mulheres)	CPOT
Dionysakopoulou et al.³¹31 Dionysakopoulou C, Giannakopoulou M, Lianou L, Bozas E, Zannikos K, Matziou V. Validation of Greek Versions of the Neonatal Infant Pain Scale and Premature Infant Pain Profile in Neonatal Intensive Care Unit. Pain Manag Nurs. 2018;19(3):313-9.	Grécia	Recém-nascidos	n=81 (44 meninos e 37 meninas)	NIPS - PIPP
Ribeiro et al.³⁷37 Ribeiro CJN, Araújo ACS, Brito SB, Dantas DV, Nunes MDS, Alves JAB, et al. Avaliação da dor de vítimas de traumatismo crânio encefálico pela versão brasileira da Behavioral Pain Scale. Rev Bras Ter Intensiva. 2018;30(1):42-9.	Brasil	Adultos	n=27 (25 homens e 02 mulheres)	BPS
Wiegand et al.³⁸38 Wiegand DL, Wilson T, Pannullo D, Russo MM, Kaiser KS, Soeken K, et al. Measuring acute pain over time in the critically ill using the Multidimensional Objective Pain Assessment Tool (MOPAT). Pain Manag Nurs. 2018;19(3):277-87.	Estados Unidos	Adultos	n=27 (13 homens e 14 mulheres)	MOPAT
Sulla et al.²⁰20 Sulla F, de Souza Ramos N, Terzi N, Trenta T, Uneddu M, Zaldivar Cruces MA, et al. Validation of the Italian version of the Critical Pain Observation Tool in brain-injured critically ill adults. Acta Biomed. 2017;88(5S):48-54.	Itália	Adultos	n=50	CPOT
Kotfis et al.³⁹39 Kotfis K, Zegan-Baranska M, Strzelbicka M, Safranow K, Zukowski M, Ely EW. Validation of the Polish version of the Critical Care Pain Observation Tool (CPOT) to assess pain intensity in adult, intubated intensive care unit patients: the POL-CPOT study. Arch Med Sci. 2018;14(4):880-9.	Polônia	Adultos	n=71 (50 homens e 21 mulheres)	CPOT
Chookalayia et al.¹⁸18 Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, Aghamohammadi-Kalkhoranb M, Karimollahi M. The critical care pain observation tool is reliable in non-agitated but not in agitated intubated patients. Intensive Crit Care Nurs. 2017;44:123-8.	Irã	Adultos	n=65	CPOT
Rijkenberg et al.⁴⁰40 Rijkenberg S, Stilma W, Bosman RJ, van der Meer NJ, van der Voort PHJ. Pain measurement in mechanically ventilated patients after cardiac surgery: comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth. 2017;31(4)1227-34.	Holanda	Adultos	n=72 (52 homens e 20 mulheres)	BPS - CPOT
Cheng et al.³²32 Cheng LH, Tsaib YF, Wang CH, Tsay PK. Validation of two Chinese-version pain observation tools in conscious and unconscious critically ill patients. Intensive Crit Care Nurs. 2018;44:115-22.	China	Adultos	n=113 (73 homens e 40 mulheres)	BPS - CPOT
Gélinas et al.⁴¹41 Gélinas C, Puntillo KA, Levin P, Azoulay E. The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries. Pain. 2017;158(5):811-21.	28 países	Adultos	n=3851 (60,8% homens e 39,2% mulheres)	BPAT
Azevedo-Santos et al.⁴²42 Azevedo-Santos IF, Alves IGN, Cerqueira Neto ML, Badauê-Passos D, Santana Filho VJ, Santana JM. Validação da versão Brasileira da Escala Comportamental de Dor (Behavioral Pain Scale) em adultos sedados e sob ventilação mecânica. Rev Bras Anestesiol. 2017;67(3):271-7.	Brasil	Adultos	n=25 (10 homens e 15 mulheres)	BPS
Hylén et al.¹⁵15 Hylén M, Akerman E, Alm-Roijer C, Idvall E. Behavioral Pain Scale - translation, reliability, and validity in a Swedish context. Acta Anaesthesiol Scand. 2016;60(6)821-8.	Suécia	Adultos	n=20	BPS
Severgnini et al.⁴³43 Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chiaranda M. Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016;7(4):68.	Itália	Adultos	n=101 (64 homens e 37 mulheres)	BPS - CPOT
Al Darwish, Hamdi e Fallatah⁴⁴44 Al Darwish ZQ, Hamdi R, Fallatah S. Evaluation of pain assessment tools in patients receiving mechanical ventilation. AACN Adv Crit Care. 2016;27(2):162-72.	Arábia Saudita	Adultos	n=47 (27 homens e 20 mulheres)	BPS - CPOT - NVPS
O'Sullivan et al.¹⁶16 O'Sullivan AT, Rowley S, Ellis S, Faasse K, Petrie KJ. The validity and clinical utility of the COVERS Scale and Pain Assessment Tool for Assessing Pain in Neonates Admitted to an Intensive Care Unit. Clin J Pain. 2016;32(1):51-7.	Nova Zelândia	Crianças	n=80	COVERS - PAT
Aktas e Karabulut⁴⁵45 Aktas YY, Karabulut N. A Turkish version of the Critical-Care Pain Observation Tool: reliability and validity assessment. J Perianesth Nurs. 2017;32(4)341-51.	Turquia	Adultos	n=66 (48 homens e 18 mulheres)	CPOT
Latorre-Marco et al.²³23 Latorre-Marco I, Acevedo-Nuevo M, Solís-Muñoz M, Hernández-Sánchez M, López-López C, Sánchez-Sánchez MM, et al. Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients. Med Intensiva. 2016;40(8):463-73.	Espanha	Adultos	n=190	ESCID
Frandsen et al.⁴⁶46 Frandsen JB, O'Reilly Poulsen KS, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand. 2016;60(9):1314-22.	Dinamarca	Adultos	n=70 (44 homens e 26 mulheres)	CPOT
Joffe et al.¹⁹19 Joffe AM, McNulty B, Boitor M, Marsh R, Gélinas C. Validation of the Critical-Care Pain Observation Tool in the brain-injured critically ill adults. J Crit Care. 2016;36:76-80.	Canadá	Adultos	n=79	CPOT
Chen et al.⁴⁷47 Chen J, Lu Q, Wu XY, An YZ, Zhan YC, Zhang HY. Reliability and validity of the Chinese version of the behavioral pain scale in intubated and non-intubated critically ill patients: two cross-sectional studies. Int J Nurs Stud. 2016;61:63-71.	China	Adultos	n=53 (26 homens e 27 mulheres)	BPS
Rahu et al.⁴⁸48 Rahu MA, Grap MJ, Ferguson P, Joseph P, Sherman S, Elswick RK Jr. Validity and sensitivity of 6 pain scales in critically ill, intubated adults. Am J Crit Care. 2015;24(6):514-23.	Estados Unidos	Adultos	n=150 (78 homens e 72 mulheres)	NVPS - BPS - FACES - FLACC - COMFORT - NRP
Azevedo-Santos et al.⁶6 Azevedo-Santos IF, Alves IG, Badauê-Passos D, Santana-Filho VJ, DeSantana JM. Psychometric analysis of Behavioral Pain Scale Brazilian Version in sedated and mechanically ventilated adult patients: a preliminary study. Pain Pract. 2015;16(4):451-8.	Brasil	Adultos	n=15 (12 homens e 03 mulheres)	BPS
Liu, Li e Herr⁴⁹49 Liu Y, Li L, Herr K. Evaluation of two observational pain assessment tools in Chinese critically ill patients. Pain Med. 2015;16(8):1622-8.	China	Adultos	n=117 (84 homens e 33 mulheres)	BPS - CPOT
Boitor, Fiola e Gélinas¹⁷17 Boitor M, Fiola JL, Gélinas C. Validation of the critical-care pain observation tool and vital signs in relation to the sensory and affective components of pain during mediastinal tube removal in postoperative cardiac surgery intensive care unit adults. J Cardiovasc Nurs. 2016;31(5):425-32.	Canadá	Adultos	n=125	CPOT
Latorre-Marco et al.²²22 Latorre-Marco I, Solís-Muñoz M, Acevedo-Nuevo M, Hernández-Sánchez ML, López-López C, Sánchez-Sánchez Mdel M, et al. Validation of the Behavioural Indicators of Pain Scale ESCID for pain assessment in non-communicative and mechanically ventilated critically ill patients: a research protocol. J Adv Nurs. 2016;72(1):205-16.	Espanha	Adultos	NI	ESCID
Navarro-Colom et al.⁵⁰50 Navarro-Colom M, Sendra-Lluis MA, Castillo-Masa AM, Robleda G. Fiabilidad interobservador y consistencia interna de la Behavioral Pain Scale en pacientes con ventilación mecânica. Enferm Intensiva. 2015;26(1):24-31.	Espanha	Adultos	n=34 (22 homens e 12 mulheres)	BPS
Li et al.⁵¹51 Li Q, Wan X, Gu C, Yu Y, Huang W, Li S, Zhang Y. Pain assessment using the critical-care pain observation tool in Chinese critically ill ventilated adults. J Pain Symptom Manage. 2014;48(5):975-82.	China	Adultos	n=63 (39 homens e 29 mulheres)	CPOT
Echegaray-Benites, Kapoustina e Gélinas⁵²52 Echegaray-Benites C, Kapoustina O, Gélinas C. Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive Crit Care Nurs. 2014;30(5):257-65.	Canadá	Adultos	n=43 (22 homens e 21 mulheres)	CPOT
Chanques et al.⁵³53 Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S, et al. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care. 2014;18(5):R160.	Estados Unidos	Adultos	n=30 (11 homens e 19 mulheres)	BPS - CPOT - NVPS
Morete et al.⁵⁴54 Morete MC, Mofatto SC, Pereira CA, Silva AP, Odierna MT. Tradução e adaptação cultural da versão portuguesa (Brasil) da escala de dor Behavioural Pain Scale. Rev Bras Ter Intensiva. 2014;26(4):373-8.	Brasil	Adultos	n=100 (61 homens e 39 mulheres)	BPS
Rijkenberg et al.⁵⁵55 Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Oudemans-van Straaten HM. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. J Crit Care. 2015;30(1):167-72.	Holanda	Adultos	n=68 (41 homens e 27 mulheres)	BPS - CPOT
Topolovec-Vranic et al.⁵⁶56 Topolovec-Vranic J, Gélinas C, Li Y, Pollmann-Mudryj MA, Innis J, McFarlan A, et al. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag. 2013;18(6):e107-14.	Canadá	Adultos	n=66 (36 homens e 30 mulheres)	CPOT - NVPS
Linde et al.⁵⁷57 Linde SM, Badger JM, Machan JT, Beaudry J, Brucker A, Martin K, et al. Reevaluation of the critical-care pain observation tool in intubated adults after cardiac surgery. Am J Crit Care. 2013;22(6):491-7.	NI	Adultos	n=30 (23 homens e 07 mulheres)	CPOT
Batalha et al.⁵⁸58 Batalha LMC, Figueiredo AM, Marques M, Bizarro V. Adaptação cultural e propriedades psicométricas da versão Portuguesa da escala Behavioral Pain Scale - Intubated Patient (BPS-IP/PT). Revista de Enfermagem Referência. 2013;9:7-16.	Portugal	Adultos	n=60 (42 homens e 18 mulheres)	BPS
Rivas, Rivas e Bustos⁵⁹59 Rivas A, Rivas E, Bustos L. Validation of a scale of assessment of pain in infants in neonatal unit. Cien Enferm. 2012;18(2):93-9.	Chile	Recém-nascidos	n=112 (69 meninos e 43 meninas)	NIPS
Chen et al.⁶⁰60 Chen YY, Lai YH, Shun SC, Chi NH, Tsai PS, Liao YM. The Chinese Behavior Pain Scale for critically ill patients: translation and psychometric testing. Int J Nurs Stud. 2011;48(4):438-48.	China	Adultos	n=70 (51 homens e 19 mulheres)	BPS
Nurnberg Damstrom et al.²⁹29 Nurnberg Damstrom D, Saboonchi F, Sackey PV, Bjorling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand. 2011;55(4):379-86.	Suécia	Adultos	n=40 (21 homens e 19 mulheres)	CPOT
Marmo e Fowler²¹21 Marmo L, Fowler S. Pain assessment tool in the critically ill post-open heart surgery patient population. Pain Manag Nurs. 2010;11(3):134-40.	Estados Unidos	Adultos	n=24	CPOT - NVPS - FLACC
Chanques et al.⁶¹61 Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J, et al. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain. 2010;151(3)711-21.	França	NI	n=111 (74 homens e 37 mulheres)
Voepel-Lewis et al.⁶²62 Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability, behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care. 2010;19(1):55-62.	Estados Unidos	Adultos e Crianças	n=29 (17 homens e 12 mulheres) n=08 (04 meninos e 03 meninas)* *Dados sobre sexo ausente para uma criança	NRS-V FLACC
Klein et al.²⁴24 Klein DG, Dumpe M, Katz E, Bena J. Pain assessment in the intensive care unit: Development and psychometric testing of the nonverbal pain assessment tool. Heart Lung. 2010;39(6):521-8.	Guiné-Bissau	Adultos	n=270	NPAT
Chanques et al.⁶³63 Chanques G, Payen JF, Mercier G, de Lattre S, Viel E, Jung B, et al. Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale. Intensive Care Med. 2009;35(12):2060-7.	França	Adultos	n=30 (20 homens e 10 mulheres)	BPS
Johansson e Kokinsky⁶⁴64 Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in pediatric intensive care. Nurs Crit Care. 2009;14(3):122-30.	Suécia	Crianças	n=40 (22 meninos e 18 meninas)	COMFORT - FLACC (modificada)
Kabes, Graves e Norris²⁵25 Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009;29(1)59-66.	Estados Unidos	Adultos	n=121	NVPS
Holsti et al.⁶⁵65 Holsti L, Grunau RE, Oberlander TF, Osiovich H. Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale. Clin J Pain. 2008;24(1)83-8.	Canadá	Prematuros	n=69 (36 meninos e 33 meninas)	BIIP
Gélinas e Johnston⁶⁶66 Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators. Clin J Pain. 2007;23(6):497-505.	Canadá	Adultos	n=55 (32 homens e 23 mulheres)	CPOT
Gélinas et al.⁶⁷67 Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420-7.	Canadá	Adultos	n=105 (83 homens e 22 mulheres)	CPOT
Young et al.⁶⁸68 Young J, Siffleet J, Nikoletti S, Shaw T. Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive Crit Care Nurs. 2006;22(1):32-9.	Austrália	Adultos	n=44 (26 homens e 18 mulheres)	BPS
Spence et al.²⁷27 Spence K, Gillies D, Harrison D, Johnston L, Nagy S. A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs. 2005;34(1):80-6.	NI	Recém-nascidos	n=144	PAT
McNair et al.²⁸28 McNair C, Ballantyne M, Dionne K, Stephens D, Stevens B. Postoperative pain assessment in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F537-41.	Canadá	NI	n=51	PIPP - CRIES
Marceau⁶⁹69 Marceau J. Pilot study of a pain assessment tool in the Neonatal Intensive Care Unit. J Paediatr Child Health. 2003;39(8):598-601.	Austrália	Recém-nascidos	n=30 (17 meninos e 13 meninas)	NNICUPAT
Payen et al.⁷⁰70 Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med. 2001;29(12):2258-63.	França	Adultos	n=30 (17 homens e 13 mulheres)	BPS

Autores	Consistência interna (α de Cronbach)	Confiabilidade (ICC)	Validade	Adaptação Transcultural
Hylén et al.³³33 Hylén M, Alm-Roijer C, Idvall E, Akerman E. To assess patients pain in intensive care: developing and testing the Swedish version of the Behavioural Pain Scale. Intensive Crit Care Nurs. 2019;52:28-34.	NI	NI	Validade discriminativa PND (IC) 0,65 (0,56 - 0,75) PD (IC) 0,28 (0,17 - 0,40)	Versão Sueca
Kaya e Erden²⁶26 Kaya P, Erden S. Cross-cultural adaptation, validity and reliability of the Turkish version of revised nonverbal pain scale. Agri. 2019;31(1):15-22.	0,776	NI	Validade de construto Teste Barlett c2= 105,433 (p<0,001)	Versão Turca
Pudas-Tähkä e Salanterä³⁰30 Pudas-Tahka S, Salantera S. Reliability of three linguistically and culturally validated pain assessment tools for sedated ICU patients by ICU nurses in Finland. Scand J Pain. 2018;18(2):165-73.	BPS: 0,86 CPOT: 0,96 NVPS: 0,90	BPS: 0,80 CPOT: 0,80 NVPS: 0,80	NI	Versão Sueca, Holandesa e Chinesa
Shan et al.³⁶36 Shan K, Cao W, Yuan Y, Hao JJ, Sun XM, He X, et al. Use of the critical-care pain observation tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation. A STROBE-compliant observational study. Medicine. 2018;97(22):e10985.	NI	0,86 a 0,93	Validade discriminativa	Versão Chinesa
Wiegand et al.³⁸38 Wiegand DL, Wilson T, Pannullo D, Russo MM, Kaiser KS, Soeken K, et al. Measuring acute pain over time in the critically ill using the Multidimensional Objective Pain Assessment Tool (MOPAT). Pain Manag Nurs. 2018;19(3):277-87.	0,68 - 0,72	NI	p<0,001	NI
Sulla et al.²⁰20 Sulla F, de Souza Ramos N, Terzi N, Trenta T, Uneddu M, Zaldivar Cruces MA, et al. Validation of the Italian version of the Critical Pain Observation Tool in brain-injured critically ill adults. Acta Biomed. 2017;88(5S):48-54.	Pacientes intubados: 0,78	NI	Correlações de Spearman: 0,42 (p<0,05) a 0,99 (p<0,001)	Versão Italiana
Kotfis et al.³⁹39 Kotfis K, Zegan-Baranska M, Strzelbicka M, Safranow K, Zukowski M, Ely EW. Validation of the Polish version of the Critical Care Pain Observation Tool (CPOT) to assess pain intensity in adult, intubated intensive care unit patients: the POL-CPOT study. Arch Med Sci. 2018;14(4):880-9.	0,89	> 0,97	Correlação de Spearman: R > 0,85, p<0,0001	Versão Polonesa
Chookalayia et al.¹⁸18 Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, Aghamohammadi-Kalkhoranb M, Karimollahi M. The critical care pain observation tool is reliable in non-agitated but not in agitated intubated patients. Intensive Crit Care Nurs. 2017;44:123-8.	02 avaliadores Antes PND: 0,79 / 0,79 Durante PND: 0,66 / 0,67 Após PND: 0,76 / 0,76 Antes PD: 0,59 / 0,64	Antes PND: 0,98 PND: 0,96 Após o PD: 0,99 Antes PD: 0,97 PD: 0,96 Após o PD: 0,98	Validade discriminativa Teste de Mann-Whitney: p<0,001	Versão Persa
Rijkenberg et al.⁴⁰40 Rijkenberg S, Stilma W, Bosman RJ, van der Meer NJ, van der Voort PHJ. Pain measurement in mechanically ventilated patients after cardiac surgery: comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth. 2017;31(4)1227-34.	CPOT Enfermeira 1: 0,65 Enfermeira 2: 0,58 BPS Enfermeira 1: 0,62 Enfermeira 2: 0,59	0,74 (0,68 - 0,79) P = 0,001	Validade discriminativa por Friedman	NI
Cheng et al.³²32 Cheng LH, Tsaib YF, Wang CH, Tsay PK. Validation of two Chinese-version pain observation tools in conscious and unconscious critically ill patients. Intensive Crit Care Nurs. 2018;44:115-22.	NI	Coeficiente Kappa: CPOT Expressão facial: 0,64 (0,31 - 0,98) / Movimentos do corpo: 1,00 (1,00 - 1,00) / Tensão muscular: 0,72 (0,43 - 1,00) / Complicação com a ventilação: 1,00 (1,00 - 1,00) BPS Expressão facial: 0,73 (0,46 - 0,99) / Membros superiores: 0,94 (0,86 - 1,00) / Complicação com a ventilação: 0,80 (0,41 - 1,00)	Validade de construto: CPOT Wald X²= 22.82 (p<0,05) BPS Wald X²= 19.71 (p<0,05)	Versão Chinesa
Gélinas et al.⁴¹41 Gélinas C, Puntillo KA, Levin P, Azoulay E. The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries. Pain. 2017;158(5):811-21.	NI	Kappa: Expressão facial neutra (0,69) Presença de careta (0,69) Estremecimento (0,60) Olhos fechados (0,70) Gemidos (0,69) Queixas verbais (0,78) Rigidez muscular (0,57) Punhos cerrados (0,62)	Validade convergente Correlação de Pearson: r = 0,79 (p<0,001)	NI
Hylén et al.¹⁵15 Hylén M, Akerman E, Alm-Roijer C, Idvall E. Behavioral Pain Scale - translation, reliability, and validity in a Swedish context. Acta Anaesthesiol Scand. 2016;60(6)821-8.	NI	Kappa: > 0,89	Validade discriminativa por Svensson PND: 0,6406 (0,4861 a 0,7951) PD: 0,1020 (0,0000 a 0,2066)	Versão Sueca
Severgnini et al.⁴³43 Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chiaranda M. Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016;7(4):68.	NI	Kappa: Antes PD: 0,69 PD: 0,64 Depois PD: 0,66	Validade discriminativa (p<0,0001)	NI
Al Darwish, Hamdi e Fallatah⁴⁴44 Al Darwish ZQ, Hamdi R, Fallatah S. Evaluation of pain assessment tools in patients receiving mechanical ventilation. AACN Adv Crit Care. 2016;27(2):162-72.	BPS: 0,95 CPOT: 0,95 NVPS: 0,86	BPS: 0,77 CPOT: 0,47 e 0,69 (durante aspiração e giro, respectivamente) NVPS: 0,72	NI	NI
Aktas e Karabulut⁴⁵45 Aktas YY, Karabulut N. A Turkish version of the Critical-Care Pain Observation Tool: reliability and validity assessment. J Perianesth Nurs. 2017;32(4)341-51.	Durante o PD: 0,72 Após o PD: 0,71	Coeficiente Kappa 0,89	Validade discriminativa: (p=0,001) Pearson: 0,63 (p<0,001)	Versão Turca
Latorre-Marco et al.²³23 Latorre-Marco I, Acevedo-Nuevo M, Solís-Muñoz M, Hernández-Sánchez M, López-López C, Sánchez-Sánchez MM, et al. Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients. Med Intensiva. 2016;40(8):463-73.	0,85	NI	Validação convergente r = 0,94 - 0,99 (p<0,001)	Versão Espanhola
Frandsen et al.⁴⁶46 Frandsen JB, O'Reilly Poulsen KS, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand. 2016;60(9):1314-22.	> 0,70	> 0,90	Validação discriminativa Correlações de Spearman	Versão Dinamarquesa
Joffe et al.¹⁹19 Joffe AM, McNulty B, Boitor M, Marsh R, Gélinas C. Validation of the Critical-Care Pain Observation Tool in the brain-injured critically ill adults. J Crit Care. 2016;36:76-80.	NI	0,727 (95% IC 0,570 - 0,833)	Validação discriminativa por Friedman: (Qui-quadrado = 150,656, p<0,001)	NI
Chen et al.⁴⁷47 Chen J, Lu Q, Wu XY, An YZ, Zhan YC, Zhang HY. Reliability and validity of the Chinese version of the behavioral pain scale in intubated and non-intubated critically ill patients: two cross-sectional studies. Int J Nurs Stud. 2016;61:63-71.	Pacientes intubados: 0,724 - 0,743 Pacientes não intubados: 0,701 - 0,762	0,962 - 1,000	Correlação Pearson Pacientes intubados: 0,815 - 0,937 Pacientes não intubados 0,755 - 0,899	Versão Chinesa
Rahu et al.⁴⁸48 Rahu MA, Grap MJ, Ferguson P, Joseph P, Sherman S, Elswick RK Jr. Validity and sensitivity of 6 pain scales in critically ill, intubated adults. Am J Crit Care. 2015;24(6):514-23.	NVPS: 0,78 BPS: 0,94 COMFORT: 0,90	NI	Correlações de Spearman NVPS PND: -0,1485 / p=0,35 PD: 0,5594 / p<0,001 BPS PND: 0,2050 / p=0,19 PD: 0,5557/ p<0,001 FACES PND: 0,2197 / p=0,18 PD: 0,7613 / p<0,001 FLACC PND: 0,1072 / p=0,50 PD: 0,6320 / p<0,001 COMFORT PND: 0,3385 / p=0,03 PD: 0,6527 / p<0,001	NI
Liu et al.⁴⁹49 Liu Y, Li L, Herr K. Evaluation of two observational pain assessment tools in Chinese critically ill patients. Pain Med. 2015;16(8):1622-8.	CPOT: 0,795 BPS: 0,791	NI	CPOT Z = - 14,352 p<0,001 BPS Z = -14,440 (p<0,001)	Versão Chinesa
Boitor, Fiola e Gélinas¹⁷17 Boitor M, Fiola JL, Gélinas C. Validation of the critical-care pain observation tool and vital signs in relation to the sensory and affective components of pain during mediastinal tube removal in postoperative cardiac surgery intensive care unit adults. J Cardiovasc Nurs. 2016;31(5):425-32.	NI	Repouso: 0,863 PND: 0,956 Repouso: 0,535 PD: 0,828	Validade discriminativa Teste de Mauchly: (p<0,001) Validade convergente: r = 0,313 (p<0,01)	NI
Latorre-Marco et al.²²22 Latorre-Marco I, Solís-Muñoz M, Acevedo-Nuevo M, Hernández-Sánchez ML, López-López C, Sánchez-Sánchez Mdel M, et al. Validation of the Behavioural Indicators of Pain Scale ESCID for pain assessment in non-communicative and mechanically ventilated critically ill patients: a research protocol. J Adv Nurs. 2016;72(1):205-16.	0,70 a 0,80	NI	Correlações de Pearson Antes da avaliação: 0,97 Durante a avaliação: 0,94 Após a avaliação: 0,95	Versão Espanhola
Navarro-Colom et al.⁵⁰50 Navarro-Colom M, Sendra-Lluis MA, Castillo-Masa AM, Robleda G. Fiabilidad interobservador y consistencia interna de la Behavioral Pain Scale en pacientes con ventilación mecânica. Enferm Intensiva. 2015;26(1):24-31.	PND: 0,66 (IC 95% 0,33-0,83) PD: 0,73 (IC 95%: 0,50-0,87)	PND: 0,50 (IC 95%: 0,19 - 0,71) PD: 0,58 (IC 95%: 0,31 - 0,77)	NI	NI
Li et al.⁵¹51 Li Q, Wan X, Gu C, Yu Y, Huang W, Li S, Zhang Y. Pain assessment using the critical-care pain observation tool in Chinese critically ill ventilated adults. J Pain Symptom Manage. 2014;48(5):975-82.	0,59 a 0,86	0,80 a 0,91	Validação discriminativa Correlações de Spearman: 0,81 a 0,93	Versão Chinesa
Echegaray-Benites, Kapoustina e Gélinas et al.⁵²52 Echegaray-Benites C, Kapoustina O, Gélinas C. Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive Crit Care Nurs. 2014;30(5):257-65.	NI	> 0,75	Teste Wilcoxon com correção de Bonferroni: (Z = 5,14, p<0,001) AUC: 0,864, P < 0,001 (IC 95% = 0,757 - 0,971)	NI
Chanques et al.⁵³53 Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S, et al. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care. 2014;18(5):R160.	BPS: 0,80 CPOT: 0,81 NVPS: 0,76	Kappa: BPS: 0,81 CPOT: 0,81 NVPS: 0,71	BPS: 0,90 CPOT: 0,86 NVPS: 0,92	NI
Rijkenberg et al.⁵⁵55 Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Oudemans-van Straaten HM. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. J Crit Care. 2015;30(1):167-72.	CPOT: 0,71 BPS: 0,70	CPOT 0,75 (0,69 - 0,79) p=0,001 BPS 0,74 (0,68 - 0,79) p=0,001	Validade discriminativa por Friedman e Wilcoxon	Versão Inglesa
Topolovec-Vranic et al.⁵⁶56 Topolovec-Vranic J, Gélinas C, Li Y, Pollmann-Mudryj MA, Innis J, McFarlan A, et al. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag. 2013;18(6):e107-14.	0,36 a 0,75	0,62 a 0,68	Validade discriminativa por ANOVA CPOT: F = 5,81 p=0,019 NVPS-R: F = 5,32 (p=0,025 Validação de critério: 0,59 a 0,71 (p<0,05)	NI
Linde et al.⁵⁷57 Linde SM, Badger JM, Machan JT, Beaudry J, Brucker A, Martin K, et al. Reevaluation of the critical-care pain observation tool in intubated adults after cardiac surgery. Am J Crit Care. 2013;22(6):491-7.	NI	Coeficiente Kappa: 0,87 (95% IC, 0,79 -0,94)	Validade concorrente	NI
Batalha et al.⁵⁸58 Batalha LMC, Figueiredo AM, Marques M, Bizarro V. Adaptação cultural e propriedades psicométricas da versão Portuguesa da escala Behavioral Pain Scale - Intubated Patient (BPS-IP/PT). Revista de Enfermagem Referência. 2013;9:7-16.	0,65 - 0,73	0,79 (0,67 - 0,87)		Versão Portuguesa
Chen et al.⁶⁰60 Chen YY, Lai YH, Shun SC, Chi NH, Tsai PS, Liao YM. The Chinese Behavior Pain Scale for critically ill patients: translation and psychometric testing. Int J Nurs Stud. 2011;48(4):438-48.	NI	NI	Correlação de Pearson: r = 0.50 - 1.00 (P < 0.001) Validade discriminativa por ANOVA (F = 377.7 p<0,001)	Versão Chinesa
Nurberg-Damstrom et al.²⁹29 Nurnberg Damstrom D, Saboonchi F, Sackey PV, Bjorling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand. 2011;55(4):379-86.	0,31 - 0,81	0,84 (0,72 - 0,92)	Correlações de Spearman: 0,32 - 0,45	Versão Sueca
Marmo e Fowler²¹21 Marmo L, Fowler S. Pain assessment tool in the critically ill post-open heart surgery patient population. Pain Manag Nurs. 2010;11(3):134-40.	0,89	NI	Correlações de Pearson	NI
Chanques et al.⁶¹61 Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J, et al. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain. 2010;151(3)711-21.	NI	NI	Correlações de Pearson	NI
Klein et al.²⁴24 Klein DG, Dumpe M, Katz E, Bena J. Pain assessment in the intensive care unit: Development and psychometric testing of the nonverbal pain assessment tool. Heart Lung. 2010;39(6):521-8.	0,82	NI	Validade de construto (p<0,001)	NI
Voepel-Lewis et al.⁶²62 Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability, behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care. 2010;19(1):55-62.	0,882	0,67 - 0,95	Validade de construto PD: 5,27 SD 2,3 PND: 0,52 SD 1,1 (p<0,001)	NI
Chanques et al.⁶³63 Chanques G, Payen JF, Mercier G, de Lattre S, Viel E, Jung B, et al. Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale. Intensive Care Med. 2009;35(12):2060-7.	0,79	0,57 - 0,59 Coeficiente Kappa: 0,89 / 0,82	Validação discriminativa	NI
Gélinas e Johnston⁶⁶66 Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators. Clin J Pain. 2007;23(6):497-505.	NI	Antes PD: 0,80 PD: 0,88 Após PD: 0,92 Antes PD: 0,84 PD: 0,84 Após PD: 0,93	Validade discriminativa por RM-MANOVA Coeficiente de Pearson: (p≤0,05)	Versão Inglesa
Gélinas et al.⁶⁷67 Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420-7.	NI	NI	Validade discriminativa por ANOVA Correlações de Spearman: 0,49, 0,59 e 0,40 (p≤0,001)	NI
Young et al.⁶⁸68 Young J, Siffleet J, Nikoletti S, Shaw T. Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive Crit Care Nurs. 2006;22(1):32-9.	0,64	NI	NI	NI
McNair et al.²⁸28 McNair C, Ballantyne M, Dionne K, Stephens D, Stevens B. Postoperative pain assessment in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F537-41.	NI	Antes da cirurgia: 0,60 72 horas após a cirurgia: 0,25	Validade convergente	NI
Kabes, Graves e Norris²⁵25 Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009;29(1)59-66.	Antes PD: 0,36 PD: 0,62 Após PD: 0,62	NI	Correlações de Spearman 135,86 p<0,001	NI
Payen et al.⁷⁰70 Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med. 2001;29(12):2258-63.	NI	Coeficiente Kappa: 0,74 (p<0,01)	NI	NI

Autores	Consistência interna (Cronbach)	Confiabilidade (ICC)	Validade	Adaptação Transcultural
Klein et al.³⁴34 Klein C, Caumo W, Gélinas C, Patines V, Pilger T, Lopes A, et al. Validation of two pain assessment tools using a standardized nociceptive stimulation in critically ill adults. J Pain Symptom Manage. 2018;56(4):594-601.	NI	Coeficiente Kappa: Algometria de pressão CPOT / BPS 0,96 (0,95 - 0,97) e 0,96 (0,94 - 0,97), (p<0,001), respectivamente. Cuidados padrão CPOT / BPS 0,96 (0,94 - 0,97) e 0,94 (0,92 - 0,95), (p<0.001), respectivamente.	Validade preditiva: CPOT 0,44 (0,35 - 0,65) BPS 0,44 (0,52 - 0,87)	Versão Brasileira
Ribeiro et al.³⁷37 Ribeiro CJN, Araújo ACS, Brito SB, Dantas DV, Nunes MDS, Alves JAB, et al. Avaliação da dor de vítimas de traumatismo crânio encefálico pela versão brasileira da Behavioral Pain Scale. Rev Bras Ter Intensiva. 2018;30(1):42-9.	NI	0,95 (0,90 - 0,98) Kappa:0,70	Validade discriminativa por Friedman e Wilcoxon p < 0,0001	Versão Brasileira
Santos et al.⁴²42 Azevedo-Santos IF, Alves IGN, Cerqueira Neto ML, Badauê-Passos D, Santana Filho VJ, Santana JM. Validação da versão Brasileira da Escala Comportamental de Dor (Behavioral Pain Scale) em adultos sedados e sob ventilação mecânica. Rev Bras Anestesiol. 2017;67(3):271-7.	PND (0,8) PD (0,8)	PND (0,8) PD (0,9)	Validade de critério: PAS: 0,35 (P = 0,86) PAD: -0,83 (P = 0,69) PAM: -0,17 (P = 0,93) FC: -0,30 (P = 0,89) SpO2: 0,11 (P = 0,61) Ramsay: -0,34 (P = 0,10) RASS: 0,32 (P = 0,12) Apache II: -0,03 (P=0,8) Validade de construto - teste de hipótese (p ≤ 0,0001)	Versão Brasileira
Azevedo-Santos et al.³⁶36 Shan K, Cao W, Yuan Y, Hao JJ, Sun XM, He X, et al. Use of the critical-care pain observation tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation. A STROBE-compliant observational study. Medicine. 2018;97(22):e10985.	Repouso (0,42) PND (0,53) PD (0,57)	Repouso e PD (0,65) PND (0,53)	Teste de Friedman e Teste de Tukey	Versão Brasileira
Morete et al.⁵⁴54 Morete MC, Mofatto SC, Pereira CA, Silva AP, Odierna MT. Tradução e adaptação cultural da versão portuguesa (Brasil) da escala de dor Behavioural Pain Scale. Rev Bras Ter Intensiva. 2014;26(4):373-8.	0,501	Kappa:0,740 ICC de 0,807 (IC 95%: 0,727 - 0,866)	NI	Versão Portuguesa (Brasil)

Autores	Consistência interna (α de Cronbach)	Confiabilidade (ICC)	Validade	Adaptação Transcultural
Sulla et al.¹⁴14 Sulla F, La Chimia M, Barbieri L, Gigantiello A, Iraci C, Virgili G, et al. A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients. Acta Biomed. 2018;89(7-S):19-24.	0,865	NI	Validade discriminativa (ROC): 0,995 (p<0,001; e.s.= 0,007; I.C. 95% [0,982; 1,009])	Versão Italiana
Fagioli et al.³⁵35 Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ràva L, et al. Pain assessment in pediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People. 2018;30(5):27-33.	PND: 0,81 PD: 0,91	Kappa: 0,558	NI	Versão Italiana
Dionysakopoulou et al.³¹31 Dionysakopoulou C, Giannakopoulou M, Lianou L, Bozas E, Zannikos K, Matziou V. Validation of Greek Versions of the Neonatal Infant Pain Scale and Premature Infant Pain Profile in Neonatal Intensive Care Unit. Pain Manag Nurs. 2018;19(3):313-9.	NIPS: 0,87 - 0,95 PIPP: 0,93 - 0,96	> 0,98	Validade de critério	Versão Grega
O'Sullivan et al.¹⁶16 O'Sullivan AT, Rowley S, Ellis S, Faasse K, Petrie KJ. The validity and clinical utility of the COVERS Scale and Pain Assessment Tool for Assessing Pain in Neonates Admitted to an Intensive Care Unit. Clin J Pain. 2016;32(1):51-7.	COVERS PND: 0,74 PD: 0,79 PAT PND: 0,79 PD: 0,85	COVERS PND: 0,82 PD: 0,80 PAT PND: 0,83 PD: 0,86	Spearman: r = 0,81 (p=0,001)	NI
Rivas et al.⁵⁹59 Rivas A, Rivas E, Bustos L. Validation of a scale of assessment of pain in infants in neonatal unit. Cien Enferm. 2012;18(2):93-9.	0,78	NI	Técnica de rotação Varimax e normalização com Kaiser	NI
Johansson e Kokinsky⁶⁴64 Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in pediatric intensive care. Nurs Crit Care. 2009;14(3):122-30.	NI	Coeficiente Kappa: COMFORT-B 0,71 (0,75 - 0,77) FLACC 0,63 (0,53 - 0,72)	Validade concorrente 0,76 (p<0,05)
Holsti et al.⁶⁵65 Holsti L, Grunau RE, Oberlander TF, Osiovich H. Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale. Clin J Pain. 2008;24(1)83-8.	NI	NI	Validade discriminativa por ANOVA	NI
Spence et al.²⁷27 Spence K, Gillies D, Harrison D, Johnston L, Nagy S. A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs. 2005;34(1):80-6.	NI	0,84	Correlações de Pearson 0,76 (p<0,001)	NI
Marceau⁶⁹69 Marceau J. Pilot study of a pain assessment tool in the Neonatal Intensive Care Unit. J Paediatr Child Health. 2003;39(8):598-601.	NI	NI	Validade discriminativa por ANOVA	NI

Autores	1	2	3	4	5	6	7	8	9
Hylén et al.³³33 Hylén M, Alm-Roijer C, Idvall E, Akerman E. To assess patients pain in intensive care: developing and testing the Swedish version of the Behavioural Pain Scale. Intensive Crit Care Nurs. 2019;52:28-34.	NI	NI	NI	+	NI	NI	NI	+	NI
Kaya e Erden²⁶26 Kaya P, Erden S. Cross-cultural adaptation, validity and reliability of the Turkish version of revised nonverbal pain scale. Agri. 2019;31(1):15-22.	NI	NI	+	+	NI	NI	NI	+	NI
Sulla et al.¹⁴14 Sulla F, La Chimia M, Barbieri L, Gigantiello A, Iraci C, Virgili G, et al. A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients. Acta Biomed. 2018;89(7-S):19-24.	NI	NI	+	+	NI	NI	NI	+	NI
Klein et al.³⁴34 Klein C, Caumo W, Gélinas C, Patines V, Pilger T, Lopes A, et al. Validation of two pain assessment tools using a standardized nociceptive stimulation in critically ill adults. J Pain Symptom Manage. 2018;56(4):594-601.	NI	NI	NI	+	+	NI	+	NI	NI
Pudas-Tähkä e Salanterä³⁰30 Pudas-Tahka S, Salantera S. Reliability of three linguistically and culturally validated pain assessment tools for sedated ICU patients by ICU nurses in Finland. Scand J Pain. 2018;18(2):165-73.	NI	NI	+	+	+	NI	NI	NI	NI
Fagioli et al.³⁵35 Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ràva L, et al. Pain assessment in pediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People. 2018;30(5):27-33.	NI	NI	+	+	+	NI	NI	NI	NI
Shan et al.³⁶36 Shan K, Cao W, Yuan Y, Hao JJ, Sun XM, He X, et al. Use of the critical-care pain observation tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation. A STROBE-compliant observational study. Medicine. 2018;97(22):e10985.	NI	NI	NI	+	+	NI	NI	+	NI
Ribeiro et al.³⁷37 Ribeiro CJN, Araújo ACS, Brito SB, Dantas DV, Nunes MDS, Alves JAB, et al. Avaliação da dor de vítimas de traumatismo crânio encefálico pela versão brasileira da Behavioral Pain Scale. Rev Bras Ter Intensiva. 2018;30(1):42-9.	NI	NI	NI	+	+	NI	NI	+	NI
Dionysako- poulou et al.³¹31 Dionysakopoulou C, Giannakopoulou M, Lianou L, Bozas E, Zannikos K, Matziou V. Validation of Greek Versions of the Neonatal Infant Pain Scale and Premature Infant Pain Profile in Neonatal Intensive Care Unit. Pain Manag Nurs. 2018;19(3):313-9.	NI	NI	+	+	+	NI	+	NI	NI
Wiegand et al.³⁸38 Wiegand DL, Wilson T, Pannullo D, Russo MM, Kaiser KS, Soeken K, et al. Measuring acute pain over time in the critically ill using the Multidimensional Objective Pain Assessment Tool (MOPAT). Pain Manag Nurs. 2018;19(3):277-87.	NI	NI	+	NI	NI	NI	NI	+	NI
Sulla et al.²⁰20 Sulla F, de Souza Ramos N, Terzi N, Trenta T, Uneddu M, Zaldivar Cruces MA, et al. Validation of the Italian version of the Critical Pain Observation Tool in brain-injured critically ill adults. Acta Biomed. 2017;88(5S):48-54.	NI	NI	+	+	NI	NI	NI	+	NI
Kotfis et al.³⁹39 Kotfis K, Zegan-Baranska M, Strzelbicka M, Safranow K, Zukowski M, Ely EW. Validation of the Polish version of the Critical Care Pain Observation Tool (CPOT) to assess pain intensity in adult, intubated intensive care unit patients: the POL-CPOT study. Arch Med Sci. 2018;14(4):880-9.	NI	NI	+	+	+	NI	NI	+	NI
Chookalayia et al.¹⁸18 Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, Aghamohammadi-Kalkhoranb M, Karimollahi M. The critical care pain observation tool is reliable in non-agitated but not in agitated intubated patients. Intensive Crit Care Nurs. 2017;44:123-8.	NI	NI	+	+	+	NI	NI	+	NI
Rijkenberg et al.⁴⁰40 Rijkenberg S, Stilma W, Bosman RJ, van der Meer NJ, van der Voort PHJ. Pain measurement in mechanically ventilated patients after cardiac surgery: comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth. 2017;31(4)1227-34.	NI	NI	+	NI	+	NI	NI	+	NI
Cheng et al.³²32 Cheng LH, Tsaib YF, Wang CH, Tsay PK. Validation of two Chinese-version pain observation tools in conscious and unconscious critically ill patients. Intensive Crit Care Nurs. 2018;44:115-22.	NI	NI	NI	+	+	NI	NI	+	NI
Gélinas et al.⁴¹41 Gélinas C, Puntillo KA, Levin P, Azoulay E. The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries. Pain. 2017;158(5):811-21.	NI	NI	NI	NI	+	NI	NI	+	NI
Azevedo-Santos et al.⁴²42 Azevedo-Santos IF, Alves IGN, Cerqueira Neto ML, Badauê-Passos D, Santana Filho VJ, Santana JM. Validação da versão Brasileira da Escala Comportamental de Dor (Behavioral Pain Scale) em adultos sedados e sob ventilação mecânica. Rev Bras Anestesiol. 2017;67(3):271-7.	NI	NI	+	+	+	NI	NI	+	NI
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