Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients.
OBJECTIVE
Sedation scales are used to guide sedation protocols in intensive care units (ICUs). However, no sedation scale in Portuguese has ever been evaluated. The aim of this study was to evaluate the validity and reliability of Portuguese translations of four sedation-agitation scales, among critically ill patients: Glasgow Coma Score, Ramsay, Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS).


METHODS
Validation study in two mixed ICUs of a university hospital.


METHODS
All scales were applied to 29 patients by four different critical care team members (nurse, physiotherapist, senior critical care physician and critical care resident). We tested each scale for interrater reliability and for validity, by correlations between them. Interrater agreement was measured using weighted kappa (k) and correlations used Spearman's test.


RESULTS
136 observations were made on 29 patients. All scales had at least substantial agreement (weighted k 0.68-0.90). RASS (weighted k 0.82-0.87) and SAS (weighted k 0.83-0.90) had the best agreement. All scales had a good and significant correlation with each other.


CONCLUSIONS
All scales demonstrated good interrater reliability and were comparable. RASS and SAS showed the best correlations and the best agreement results in all professional categories. All these characteristics make RASS and SAS good scales for use at the bedside, to evaluate sedation-agitation among critically ill patients in terms of validity, reliability and applicability.
Nassar Junior
Antonio Paulo
AP
Faculdade deMedicina da Universidade de São Paulo, Discipline of Medical Emergencies, Hospital das Clínicas, São Paulo, Brazil. paulo_nassar@yahoo.com.br
Pires Neto
Ruy Camargo
RC
de Figueiredo
Walquiria Barcelos
WB
Park
Marcelo
M
D000368:Aged; D001938:Brazil; D016292:Procedural Sedation / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007802:Language; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D015588:Observer Variation; D010348:Patient Care Team; D011595:Psychomotor Agitation / Q000175:diagnosis*; D015203:Reproducibility of Results