Reliability of the Sedation-Agitation Scale between nurses and doctors

Summary 

This study determined the inter-rater reliability of the Sedation-Agitation Scale (SAS) when used by staff in a tertiary level general intensive care unit (ICU). The study was designed to answer the question in the ‘real world’, with minimum patient exclusion criteria, do nurses and doctors rate ICU patient's sedation levels using the SAS similarly? A convenient sample of 35 nursing and seven medical staff and a randomly selected sample of 69 patients were used. A nurse and a doctor rated each patient simultaneously using the SAS, with a systematic five-stage arousal process. The results showed that there was exact agreement between the nurses’ and doctors’ scores in 74% of assessments. The weighted kappa finding of 0.82 indicates very good agreement (reliability). The mean SAS scores recorded for nurses (2.33±1.21) and doctors (2.36±1.35) were similar. Intraclass correlations for single measures (r=.921, p<.001) and average measures (r=.959, p<.001) indicated individuals who completed multiple ratings did not introduce bias. Where there was a difference between the paired ratings, these were only one level of the SAS away from each other. This research indicates nurses and doctors rate patients’ levels of sedation similarly using the SAS. It also provides support for the use of the instrument in general ICUs outside the USA. Research is now needed to determine the value of the SAS in guiding clinical decision-making related to sedation management.

Keywords: Sedation, Agitation, Intensive care unit, Reliability