Reliability of Four Sedation Assessment Scales

Monitoring Sedation Status Over Time in ICU Patients

“…28 It has been common to consider sedation scales valid as long as they delineate levels of arousal (considered a surrogate of consciousness). 20,[23][24][25]49 Consciousness, however, is classically defined as the combination of a person's level of arousal plus the content of consciousness (eg, delirium). 30 Only recently has the ICU community begun to focus on delirium as an essential element of patient comfort and outcome.…”

Daily Interruption of Continuous Sedation

“…To answer some of these questions, the psychological impact of daily sedation interruption was investigated. 10 Patients who received daily interruption who were alive at least 6 months after hospital discharge were invited to participate; this protocol group consisted of 13 patients. The control group consisted of 19 patients from the medical ICU who did not receive daily sedation interruption.…”

Sedation Assessment in Critically Ill Adults

“…Most sedation assessment instruments allow the assessor to choose one categorical response under a single domain. 29-31,33, 35-39,42,44-47,52, 54 The remaining scales incorporate additional clinical items in each score (e.g., hemodynamic parameters, ventilatory variables) and tend to produce a wider range of values. 32,34,40,41,53, 55 While scales incorporating a single categorical assessment are probably simpler to use at the bedside, their validity is likely compromised if one attempts to assess discordant conditions (e.g., pain and ventilator synchrony) using a single numeric score.…”

“…Twelve studies evaluating the validity and/or reliability of nine sedation assessment instruments were identified (Table 2). 47,52-55,57,65-69 Five studies published descriptions of the evaluative results conjointly with the original instrument along with results of their evaluation: the MAAS, 47 the Hahnemann Sedation Assessment Scale (HSAS), 54 the Vancouver Interaction and Calmness Scale (VICS), 53 the SAS, 57 and the RASS. 52 Results from psychometric assessments were published for four others after the original description of the instrument.…”

“…The reliability of the Ramsay scale, 67 the New Sheffield Sedation Scale, 68 the SAS, 57,69 the MAAS, 47 the HSAS, 54 the VICS, 53 the RASS, 52 and the Agitation/Sedation Scale 55 was high, reflected in overall correlation coefficients of 0.87 to 0.96, and κ values of 0.66-0.94. In one recent reliability study 54 of the SAS, it is unclear why the correlation coefficient was only 0.52 (p < 0.001, κ 0.34; p = 0.085), especially since repeat reliability testing in a group of ICU nurses untrained in the use of SAS showed excellent reliability (κ 0.85-0.93). 71 In the nine reliability studies 47,52-55,57,68,69 of nine scales that were identified, all evaluations were paired, with one assessor always being an ICU nurse familiar with the patient.…”