Comparison and agreement between the richmond agitation-sedation scale and the riker sedation-agitation scale in evaluating patients' eligibility for delirium assessment in the ICU

Babar Khan, Oscar Guzman, Noll L. Campbell, Todd Walroth, Jason L. Tricker, Siu Hui, Anthony Perkins, Mohammed Zawahiri, John D. Buckley, Mark O. Farber, E. Wesley Ely, Malaz Boustani

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU(CAM-ICU). Methods: We performed a prospective cohort study in the adult medical, surgical, and progressive (step-down) ICUs of a tertiary care, university-affiliated, urban hospital in Indianapolis, Indiana. The cohort included 975 admissions to the ICU between January and October 2009. Results: The outcome measures of interest were the correlation and agreement between RASS and SAS measurements. In 2,469 RASS and SAS paired screens, the rank correlation using the Spearman correlation coefficient was 0.91, and the agreement between the two screening tools for assessing CAM-ICU eligibility as estimated by the k coefficient was 0.93. Analysis showed that 70.1% of screens were eligible for CAM-ICU assessment using RASS(7.1% sedated [RASS -3 to -1]; 62.6% calm [0]; and 0.4% restless, agitated [+1 to +3]), compared with 72.1% using SAS(5% sedated [SAS 3]; 66.5% calm [4]; and 0.6% anxious, agitated [5, 6]). In the mechanically ventilated subgroup, RASS identified 19.1% CAM-ICU eligible patients compared with 24.6% by SAS. The correlation coefficient in this subgroup was 0.70 and the agreement was 0.81. Conclusion: Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU.

Original languageEnglish
Pages (from-to)48-54
Number of pages7
JournalChest
Volume142
Issue number1
DOIs
StatePublished - Jul 2012

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Delirium
Confusion
Arousal
Urban Hospitals
Tertiary Healthcare
Consciousness
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Comparison and agreement between the richmond agitation-sedation scale and the riker sedation-agitation scale in evaluating patients' eligibility for delirium assessment in the ICU. / Khan, Babar; Guzman, Oscar; Campbell, Noll L.; Walroth, Todd; Tricker, Jason L.; Hui, Siu; Perkins, Anthony; Zawahiri, Mohammed; Buckley, John D.; Farber, Mark O.; Ely, E. Wesley; Boustani, Malaz.

In: Chest, Vol. 142, No. 1, 07.2012, p. 48-54.

Research output: Contribution to journalArticle

Khan, Babar ; Guzman, Oscar ; Campbell, Noll L. ; Walroth, Todd ; Tricker, Jason L. ; Hui, Siu ; Perkins, Anthony ; Zawahiri, Mohammed ; Buckley, John D. ; Farber, Mark O. ; Ely, E. Wesley ; Boustani, Malaz. / Comparison and agreement between the richmond agitation-sedation scale and the riker sedation-agitation scale in evaluating patients' eligibility for delirium assessment in the ICU. In: Chest. 2012 ; Vol. 142, No. 1. pp. 48-54.
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abstract = "Background: Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU(CAM-ICU). Methods: We performed a prospective cohort study in the adult medical, surgical, and progressive (step-down) ICUs of a tertiary care, university-affiliated, urban hospital in Indianapolis, Indiana. The cohort included 975 admissions to the ICU between January and October 2009. Results: The outcome measures of interest were the correlation and agreement between RASS and SAS measurements. In 2,469 RASS and SAS paired screens, the rank correlation using the Spearman correlation coefficient was 0.91, and the agreement between the two screening tools for assessing CAM-ICU eligibility as estimated by the k coefficient was 0.93. Analysis showed that 70.1{\%} of screens were eligible for CAM-ICU assessment using RASS(7.1{\%} sedated [RASS -3 to -1]; 62.6{\%} calm [0]; and 0.4{\%} restless, agitated [+1 to +3]), compared with 72.1{\%} using SAS(5{\%} sedated [SAS 3]; 66.5{\%} calm [4]; and 0.6{\%} anxious, agitated [5, 6]). In the mechanically ventilated subgroup, RASS identified 19.1{\%} CAM-ICU eligible patients compared with 24.6{\%} by SAS. The correlation coefficient in this subgroup was 0.70 and the agreement was 0.81. Conclusion: Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU.",
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T1 - Comparison and agreement between the richmond agitation-sedation scale and the riker sedation-agitation scale in evaluating patients' eligibility for delirium assessment in the ICU

AU - Khan, Babar

AU - Guzman, Oscar

AU - Campbell, Noll L.

AU - Walroth, Todd

AU - Tricker, Jason L.

AU - Hui, Siu

AU - Perkins, Anthony

AU - Zawahiri, Mohammed

AU - Buckley, John D.

AU - Farber, Mark O.

AU - Ely, E. Wesley

AU - Boustani, Malaz

PY - 2012/7

Y1 - 2012/7

N2 - Background: Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU(CAM-ICU). Methods: We performed a prospective cohort study in the adult medical, surgical, and progressive (step-down) ICUs of a tertiary care, university-affiliated, urban hospital in Indianapolis, Indiana. The cohort included 975 admissions to the ICU between January and October 2009. Results: The outcome measures of interest were the correlation and agreement between RASS and SAS measurements. In 2,469 RASS and SAS paired screens, the rank correlation using the Spearman correlation coefficient was 0.91, and the agreement between the two screening tools for assessing CAM-ICU eligibility as estimated by the k coefficient was 0.93. Analysis showed that 70.1% of screens were eligible for CAM-ICU assessment using RASS(7.1% sedated [RASS -3 to -1]; 62.6% calm [0]; and 0.4% restless, agitated [+1 to +3]), compared with 72.1% using SAS(5% sedated [SAS 3]; 66.5% calm [4]; and 0.6% anxious, agitated [5, 6]). In the mechanically ventilated subgroup, RASS identified 19.1% CAM-ICU eligible patients compared with 24.6% by SAS. The correlation coefficient in this subgroup was 0.70 and the agreement was 0.81. Conclusion: Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU.

AB - Background: Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU(CAM-ICU). Methods: We performed a prospective cohort study in the adult medical, surgical, and progressive (step-down) ICUs of a tertiary care, university-affiliated, urban hospital in Indianapolis, Indiana. The cohort included 975 admissions to the ICU between January and October 2009. Results: The outcome measures of interest were the correlation and agreement between RASS and SAS measurements. In 2,469 RASS and SAS paired screens, the rank correlation using the Spearman correlation coefficient was 0.91, and the agreement between the two screening tools for assessing CAM-ICU eligibility as estimated by the k coefficient was 0.93. Analysis showed that 70.1% of screens were eligible for CAM-ICU assessment using RASS(7.1% sedated [RASS -3 to -1]; 62.6% calm [0]; and 0.4% restless, agitated [+1 to +3]), compared with 72.1% using SAS(5% sedated [SAS 3]; 66.5% calm [4]; and 0.6% anxious, agitated [5, 6]). In the mechanically ventilated subgroup, RASS identified 19.1% CAM-ICU eligible patients compared with 24.6% by SAS. The correlation coefficient in this subgroup was 0.70 and the agreement was 0.81. Conclusion: Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU.

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