title: 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.
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 κ 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.
  
  
  CONCLUSIONS
  Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU.
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN. Electronic address: bakhan@iupui.edu.
authors.forename: Babar A
authors.initials: BA
authors.lastname: Khan
authors.affiliation: Department of Pharmacy, Westchester Medical Center, Westchester, NY.
authors.forename: Oscar
authors.initials: O
authors.lastname: Guzman
authors.affiliation: Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN.
authors.forename: Noll L
authors.initials: NL
authors.lastname: Campbell
authors.affiliation: Wishard Health Services, Indianapolis, IN.
authors.forename: Todd
authors.initials: T
authors.lastname: Walroth
authors.affiliation: Wishard Health Services, Indianapolis, IN.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Tricker
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN.
authors.forename: Siu L
authors.initials: SL
authors.lastname: Hui
authors.affiliation: Regenstrief Institute, Inc, Indianapolis, IN.
authors.forename: Anthony
authors.initials: A
authors.lastname: Perkins
authors.affiliation: Regenstrief Institute, Inc, Indianapolis, IN.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Zawahiri
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN.
authors.forename: John D
authors.initials: JD
authors.lastname: Buckley
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Mark O
authors.initials: MO
authors.lastname: Farber
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN; US Department of Veterans Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN.
authors.forename: Malaz A
authors.initials: MA
authors.lastname: Boustani
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003243:Consciousness / Q000145:classification; D003693:Delirium / Q000175:diagnosis*; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000145:classification*; D007196:Indiana; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000145:classification*; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives