Is CPOT Only for Adults?
No, the CPOT is not exclusively for adults—while it was originally developed and validated for critically ill adult patients, recent research demonstrates it can be successfully adapted and validated for pediatric populations. 1
Original Development and Validation
The Critical-Care Pain Observation Tool (CPOT) was specifically designed and validated for adult ICU patients who are unable to self-report pain. 1, 2
- The Society of Critical Care Medicine's 2018 guidelines explicitly state that CPOT demonstrates the greatest validity and reliability for monitoring pain in critically ill adults unable to self-report. 1
- The original validation study in 2006 was conducted in 105 adult cardiac surgery patients. 2
- Both the 2013 and 2018 Critical Care Medicine guidelines consistently refer to CPOT as a tool for "adult ICU patients" or "critically ill adults." 1
Psychometric Properties in Adults
CPOT has exceptional psychometric performance in adult populations:
- Psychometric quality score of 16.7 out of 20, the highest among all behavioral pain scales for adults. 1, 3
- Validated across medical, surgical, and trauma ICU populations. 1
- Strong interrater reliability with moderate to high weighted kappa coefficients. 2, 4
Emerging Pediatric Applications
Recent research (2020-2025) demonstrates that CPOT can be successfully adapted for pediatric use, though this represents an expansion beyond its original intended population:
Pediatric Adaptations and Validation
- A 2020 study developed the P-CPOT (Pediatric CPOT) specifically for PICU patients unable to verbalize pain, showing excellent psychometric performance with 85% variance explained and sensitivity of 98.6%. 5
- A 2025 study validated CPOT in 91 critically ill pediatric patients, demonstrating strong correlation with FLACC (ρ = 0.84) and 100% sensitivity at a cut-off score of 3. 6
- A 2023 study validated CPOT in pediatric patients (ages 10-18) undergoing posterior spinal fusion, showing moderate positive correlation with self-reported pain. 7
Important Caveats for Pediatric Use
- P-CPOT is particularly sensitive for ventilated pediatric patients, showing 1.1 points higher scores than FLACC in this population. 5
- The pediatric validation studies are recent (2020-2025) and represent emerging evidence, not established guideline recommendations. 6, 7, 5
- In mixed-age ICUs where pediatric and adult patients are cared for together, CPOT may offer practical advantages for pain assessment across age groups. 6
Clinical Implications
For adult ICU patients: CPOT is a guideline-recommended, first-line behavioral pain assessment tool with the strongest evidence base. 1, 3
For pediatric ICU patients: While not included in formal critical care guidelines, emerging research supports CPOT's validity in children, particularly when adapted as P-CPOT. 6, 5 However, traditional pediatric scales like FLACC remain the standard of care in most pediatric settings.
Common pitfall: Assuming CPOT cannot be used in pediatrics—while it wasn't originally designed for children, recent validation studies support its use when traditional pediatric pain scales are inadequate or when caring for mixed-age populations. 6, 5