Cited by 961Intensive Care Unit Cognitive DisordersAnesthesia and Sedative AgentsFamily and Patient Care in Intensive Care Units

Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients

Riker, Richard R., Picard, Jean T., Fraser, Gilles L.·1999·Critical Care Medicine

Abstract

OBJECTIVE: Subjective scales to assess agitation and sedation in adult intensive care unit (ICU) patients have rarely been tested for validity or reliability. We revised and prospectively tested the Sedation-Agitation Scale (SAS) for interrater reliability and compared it with the Ramsay scale and the Harris scale to test construct validity. DESIGN: A convenience sample of ICU patients was simultaneously and independently examined by pairs of trained evaluators by using the revised SAS, Ramsay, and Harris Scales. SETTING: Multidisciplinary 34-bed ICU in a nonuniversity, academic medical center. PATIENTS: Forty-five ICU patients (surgical and medical) were examined a total of 69 times by evaluator pairs. MEASUREMENTS AND MAIN RESULTS: The mean patient age was 63.2 yrs, 36% were female, and 71% were intubated. When classified by using SAS, 45% were anxious or agitated (SAS 5 to 7), 26% were calm (SAS 4), and 29% were sedated (SAS 1 to 3). Interrater correlation was high for SAS (r2 = .83; p < .001) and the weighted kappa score for interrater agreement was 0.92 (p < .001). Of 41 assessments scored as Ramsay 1, 49% scored SAS 6, 41% were SAS 5, 5% were SAS 4, and 2% each were SAS 3 or 7. SAS was highly correlated with the Ramsay (r2 = .83; p < .001) and Harris (r2 = .86; p < .001) scales. CONCLUSIONS: SAS is both reliable (high interrater agreement) and valid (high correlation with the Harris and Ramsay scales) in assessing agitation and sedation in adult ICU patients. SAS provides additional information by stratifying agitation into three categories (compared with one for the Ramsay scale) without sacrificing validity or reliability.

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Crossref · 10.1097/00003246-199907000-00022

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20 of 20 references verified0 citation errors · 0 not checkable

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  • Agitation was assessed twice daily by nurses or physicians until ICU discharge using the modified Sedation-Agitation Scale (SAS).

    “Agitation was assessed twice daily by nurses or physicians until ICU discharge, by using the modified Sedation-Agitation Scale (SAS) [21] (additional data file 2).”
  • Agitation has been associated with physiologic changes producing interference with mechanical ventilation, increased oxygen consumption, and failure to cooperate with treatment.

    “Agitation has been associated with physiologic changes producing interference with mechanical ventilation, increased oxygen consumption, and failure to cooperate with treatment [21].”

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Authors
Riker, R. R., Picard, J. T., & Fraser, G. L.
Affiliations
Maine Medical Center (US)
Venue
Critical Care Medicine
Published
1999-07
Volume
27
Issue
7
Pages
1325-1329
ISSN
0090-3493 (ISSN-L)
OpenAlex
W2083091419
Cited by
961
References
20
Citations by year
2026: 22 · 2025: 44 · 2024: 38 · 2023: 28 · 2022: 30 · 2021: 38 · 2020: 28 · 2019: 38 · 2018: 41 · 2017: 35 · 2016: 48 · 2015: 45 · 2014: 47 · 2013: 43 · 2012: 51
FWCI
13.41
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
Keywords
Sedation-Agitation Scale, sedation assessment, agitation assessment, intensive care unit patients, inter-rater reliability, construct validity, scale validation
MeSH terms
Adult, Aged, Female, Humans, Hypnotics and Sedatives, Intensive Care Units, Intubation, Male, Middle Aged, Nursing Assessment, Prospective Studies, Psychometrics, Psychomotor Agitation, Reproducibility of Results, Observer Variation

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