title: The Neonatal Pain, Agitation and Sedation Scale reliably detected oversedation but failed to differentiate between other sedation levels.
abstract: OBJECTIVE
  The aim of this study was to analyse the sedation subscale of the Neonatal Pain, Agitation and Sedation Scale (N-PASS), because the N-PASS has only been validated for the assessment of acute and prolonged pain.
  
  
  METHODS
  The nurses' expert opinion regarding the level of sedation of the study patients was used as reference scale. Paired assessments of both the N-PASS sedation subscale and the nurses' expert opinion were performed in 50 sedated neonates from 23 to 44 weeks of postmenstrual age.
  
  
  RESULTS
  A total set of 503 paired observations was included into analysis. The median N-PASS sedation subscale scores were significantly different for the three nurses' expert opinion categories, with minus eight for oversedation, minus two for adequate sedation and zero for undersedation (p < 0.0001). Interobserver agreement for the N-PASS sedation subscale was excellent - linearly weighted Cohen's Kappa was 0.93 - as was the internal consistency of 0.88, estimated by a Cronbach's alpha. The internal consistency increased to 0.90 if the vital sign item of the subscale was deleted.
  
  
  CONCLUSIONS
  The N-PASS sedation subscale reliably detected oversedation, but failed to differentiate between adequate and undersedation. We therefore recommend using additional methods to ensure adequate assessment of sedation in neonates.
authors.affiliation: Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: V
authors.initials: V
authors.lastname: Giordano
authors.forename: P
authors.initials: P
authors.lastname: Deindl
authors.forename: S
authors.initials: S
authors.lastname: Kuttner
authors.forename: T
authors.initials: T
authors.lastname: Waldhör
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.forename: M
authors.initials: M
authors.lastname: Olischar
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D018730:Infant Behavior; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000523:psychology / Q000628:therapy*; D015931:Intensive Care, Neonatal; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D010147:Pain Measurement; D011595:Psychomotor Agitation / Q000175:diagnosis*; D015203:Reproducibility of Results
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives
keywords: Agitation and Sedation Scale; Assessment; Neonatal Pain; Neonates; Nurses’ expert opinion; Sedation; Subscale