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
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Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., Davidson, J. E., Devlin, J. W., Kress, J. P., Joffe, A. M., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182783b72 · Cited by 3,896
Self-citationSessler, C. N., Gosnell, M. S., Grap, M. J., Brophy, G. M., O'Neal, P. V., Keane, K. A., Tesoro, E. P., & Elswick, R. K. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.2107138 · Cited by 3,695
Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit
Ely, E. W. (2004) · JAMA · doi:10.1001/jama.291.14.1753 · Cited by 3,073
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Self-citationMonitoring Sedation Status Over Time in ICU Patients
Ely, E. W., Truman, B., Shintani, A., Thomason, J. W. W., Wheeler, A. P., Gordon, S., Francis, J., Speroff, T., Gautam, S., Margolin, R. A., et al. (2003) · JAMA · doi:10.1001/jama.289.22.2983 · Cited by 1,704
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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