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

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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

DOI 10.1097/00003246-199907000-00022

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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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Authors: Riker, R. R., Picard, J. T., & Fraser, G. L.
Affiliations: Maine Medical Center (US)
ORCID: Riker, Richard R.
Fraser, Gilles L.
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1999-07
Volume: 27
Issue: 7
Pages: 1325-1329
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/00003246-199907000-00022
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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Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients

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