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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    Chief Complaint


    Organ System


    Patent Pending

    Critical Care Pain Observation Tool (CPOT)

    Rates critically ill patients’ pain based on clinical observation.
    When to Use
    Why Use

    The CPOT can be used to assess intubated or sedated patients pain based on facial expressions, muscle tension and movement as well as compliance with ventilated breaths for intubated patients or vocalized pain for non-intubated patients.

    The Critical Care Pain Observation Tool (CPOT) was designed to assess the pain of critically ill patients who are incapable of reporting their pain.

    • The gold standard of pain assessment is patient’s self-reported pain.
    • The CPOT was created from retrospective reviews of common pain characteristics and vetted by ICU nurses and physicians.
      • Physiologic finding were removed after initial evaluation.
    • The original study included cardiac patients who were relatively healthy, only 2 data collectors performed the analysis, and one evaluation only included 33 patients out of 105.
    • CPOT scores were higher when conscious and intubated than when unconscious or extubated, which is thought to be due to endotracheal tube discomfort or positive pressure causing incision site pain.
    • CPOT scores were similar for unconscious and conscious extubated patients which may be due to lingering anesthesia or pain resolution from extubation.
    • Further analyses have validated the score in multiple post-surgical and medical ICU settings.
    • It is estimated that up to 71% of ICU patients experience untreated pain. (Gélinas 2007)
    • The Society of Intensive Care Medicine recommends routine monitoring of pain in ICU patients.
    • Treatment of pain is associated with fewer days on mechanical ventilation, decreased infections and increased satisfaction.
    • The CPOT is an innovative pain assessment tool that is based on 2 preliminary studies with expert selected variables, prior research of behavioral indicators for pain and vigorously compared scores at varying levels of consciousness.
    Relaxed, neutral
    Absence of movements
    Tense, rigid
    Very tense or rigid


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    Next Steps
    Creator Insights


    • The CPOT is designed to scale the pain of patients who are unable to report it themselves through objective findings.
    • The CPOT has good interrater reliability in multiple studies and high sensitivity when patients are in pain.


    For those patients with a CPOT score of ≤ 2:

    • There is likely minimal to no pain present. Consider re-evaluation in the future.

    For those patients with a CPOT score of >2:

    • There is an unacceptable level of pain. Consider further or alternative analgesia and sedation.

    Critical Actions

    Regular re-evaluation is crucial to appropriate pain management.

    Content Contributors
    About the Creator
    Dr. Céline Gélinas
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