The DOI matches its Crossref record; 20 of the 20 references it cites were found in a registry or an index.
Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients
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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“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).”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [21]
In the citing paper
“Agitation has been associated with physiologic changes producing interference with mechanical ventilation, increased oxygen consumption, and failure to cooperate with treatment [21].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [21]
Citations
Cites
Controlled Sedation with Alphaxalone-Alphadolone
Ramsay, M. A. E., Savege, T. M., Simpson, B. R. J., & Goodwin, R. (1974) · BMJ · doi:10.1136/bmj.2.5920.656 · Cited by 2,860
Validity and Reliability of the Observer??s
CHERNIK, D. A., Gillings, D. B., LAINE, H., Hendler, J., Silver, J., DAVIDSON, A. B., Schwam, E. M., & Siegel, J. L. (1990) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199008000-00003 · Cited by 1,246
Assessing Distress in Pediatric Intensive Care Environments: The COMFORT Scale
Ambuel, B., Hamlett, K. W., Marx, C. M., & Blumer, J. L. (1992) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/17.1.95 · Cited by 778
Prolonged sedation of critically ill patients with midazolam or propofol
Vega, R. B., Sánchez-Soria, M. M., Morales-Garcia, C., Robas-Gomez, A., Cuena, R., & Ayensa-Rincon, A. (1997) · Critical Care Medicine · doi:10.1097/00003246-199701000-00009 · Cited by 284
Hansen-Flaschen, J. H., Brazinsky, S. A., BASILE, C., & LANKIN, P. N. (1992) · Survey of Anesthesiology · doi:10.1097/00132586-199208000-00047 · Cited by 271
Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users
ROWLEY, G. L., & Fielding, K. (1991) · The Lancet · doi:10.1016/0140-6736(91)91309-i · Cited by 266
Continuous infusion of haloperidol controls agitation in critically ill patients
Riker, R. R., Fraser, G. L., & Cox, P. M. (1994) · Critical Care Medicine · doi:10.1097/00003246-199403000-00013 · Cited by 262
Self-citationPropofol vs Midazolam in Short-, Medium-, and Long-term Sedation of Critically III Patients
Carrasco, G., Molina, R., Costa, J., Soler, J. M., & Cabré, L. (1993) · CHEST Journal · doi:10.1378/chest.103.2.557 · Cited by 250
Hansen-Flaschen, J. H. (1991) · JAMA · doi:10.1001/jama.1991.03470200082040 · Cited by 250
Hansen-Flaschen, J., Cowen, J., & Polomano, R. C. (1994) · Critical Care Medicine · doi:10.1097/00003246-199405000-00004 · Cited by 181
Research works printed but not linked: 2
- Sessler, 1992, Chest, 102, 191s
- Harris, 1991, J Drug Dev, 4, 37
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You, H.-J., Lee, S., Jung, J., Cho, S., Kwon, W., Kim, J. B., & Sung, T. (2024) · Journal of International Medical Research · doi:10.1177/03000605241305474
Budniuk, O., Yovenko, I., & Havrychenko, D. (2025) · Pain medicine · doi:10.31636/pmjua.v9i3-4.1
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Metadata
- 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 › Medicine › Critical Care and Intensive Care Medicine › 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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