title: Psychometric analysis of subjective sedation scales in critically ill adults.
abstract: OBJECTIVE
  To describe and analyze the development and psychometric properties of subjective sedation scales developed for critically ill adult patients.
  
  
  METHODS
  PubMed, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, ISI Web of Science, and the International Pharmaceutical Abstracts.
  
  
  METHODS
  English-only publications through December 2012 with at least 30 patients older than 18 years, which included the key words of adult, critically ill, subjective sedation scale, sedation scale, validity, and reliability.
  
  
  METHODS
  Two independent reviewers evaluated the psychometric properties using a standardized sedation scale psychometric scoring system.
  
  
  RESULTS
  Among the 19,000+ citations extracted for the 2013 Society of Critical Care Medicine's Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium and from December 2010 to 2012, 36 articles were identified compassing 11 sedation scales. The scale development process, psychometric properties, feasibility, and implementation of sedation scales were analyzed using a 0-20 scoring system. Two scales demonstrated scores indicating "very good" published psychometric properties: Richmond Agitation-Sedation Scale (19.5) and the Sedation-Agitation Scale (19). Scores with "moderate" properties include the Vancouver Interaction and Calmness Scale (14.3), Adaptation to the Intensive Care Environment (13.7), Ramsay Sedation Scale (13.2), Minnesota Sedation Assessment Tool (13), and the Nursing Instrument for the Communication of Sedation (12.8). Scales with "low" properties included the Motor Activity Assessment Scale (11.5) and the Sedation Intensive Care Score (10.5). The New Sheffield Sedation Scale (8.5) and the Observer's Assessment of Alertness/Sedation Scale (3.7) demonstrated "very low" published properties.
  
  
  CONCLUSIONS
  Based on the current literature, and using a predetermined psychometric scoring system, the Richmond Agitation-Sedation Scale and the Sedation-Agitation Scale are the most valid and reliable subjective sedation scales for use in critically ill adult patients.
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. bryce.robinson@uc.edu
authors.forename: Bryce R H
authors.initials: BR
authors.lastname: Robinson
authors.forename: Melanie
authors.initials: M
authors.lastname: Berube
authors.forename: Juliana
authors.initials: J
authors.lastname: Barr
authors.forename: Richard
authors.initials: R
authors.lastname: Riker
authors.forename: Céline
authors.initials: C
authors.lastname: Gélinas
mesh_terms: D000328:Adult; D016292:Procedural Sedation / Q000451:nursing*; D016638:Critical Illness / Q000451:nursing*; D054810:Deep Sedation / Q000451:nursing*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D011594:Psychometrics; D015203:Reproducibility of Results
chemical_list: D006993:Hypnotics and Sedatives