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
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
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DOI：
10.1378/chest.11-2100
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发表时间：
2012-07-01
期刊：
影响因子：
9.6
通讯作者：
Boustani, Malaz A.
中科院分区：
文献类型：
--
作者：
Khan, Babar A.;Guzman, Oscar;Boustani, Malaz A.
背景：对 ICU 患者的谵妄评估需要在评估意识之前使用唤醒/镇静评估工具。 Richmond 躁动-镇静量表 (BASS) 和 Riker 镇静-躁动量表 (SAS) 是经过充分验证的唤醒/镇静工具。我们试图使用 ICU 混乱评估方法 (CAM-ICU) 来评估 BASS 和 SAS 评估的一致性，以确定 ICU 患者进行谵妄筛查的资格。方法：我们在印第安纳州印第安纳波利斯市一家三级护理、大学附属城市医院的成人内科、外科和渐进式（降级）ICU 中进行了一项前瞻性队列研究。该队列包括 2009 年 1 月至 10 月期间入住 ICU 的 975 名患者。结果：感兴趣的结果测量是 RASS 和 SAS 测量之间的相关性和一致性。在 2,469 次 RASS 和 SAS 配对筛选中，使用 Spearman 相关系数的等级相关性为 0.91，根据 K 系数估计，两种用于评估 CAM-ICU 资格的筛选工具之间的一致性为 0.93。分析显示，70.1% 的筛查符合使用 BASS 进行 CAM-ICU 评估的条件（7.1% 镇静 [BASS -3 至 -1]；62.6% 镇静 [0]；0.4% 焦躁不安、烦躁 [+1 至 +3]），而使用 SAS 的则为 72.1%（5% 镇静 [SAS 3]；66.5% 镇静 [4]；0.6% 焦虑）。激动 [5, 6])。在机械通气亚组中，RASS 确定了 19.1% 符合 CAM-ICU 资格的患者，而 SAS 确定了 24.6%。该亚组的相关系数为 0.70，一致性为 0.81。结论：SAS 和 BASS 使用 CAM-ICU 得出的谵妄评估率相似。胸部 2012； 142(1):48-54
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 (BASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of BASS 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 BASS (7.1% sedated [BASS -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 BASS led to similar rates of delirium assessment using the CAM-ICU. CHEST 2012; 142(1):48-54