Confirming the reliability of the sedation-agitation scale administered by ICU nurses without experience in its use

Study Objectives. To determine the validity and reliability of the Sedation-Agitation scale (SAS) When administered by intensive care unit (ICU) nurses with no experience in its use. Design. Prospective, psychometric evaluation. Setting. Adult medical-cardiac ICU. Patients. Sixty patients. Intervention. Sedation and agitation were observed simultaneously but independently by nurses and two investigators, and patients were rated with the SAS. The assessment of an experienced clinical nurse specialist was recorded on visual analog scales (VAS) for sedation (VAS-S) and agitation (VAS-A). Measurements and Main Results. The SAS scores of ICU staff nurses were compared with VAS scored by the clinical nurse specialist using Pearson correlation coefficient. The SAS correlated well with VAS-S (Spearman's rho = -0.77, p <0.001). Neither SAS nor VAS-A was correlated (Spearman's p = 0.05, p >0.5), but there were few observations of agitated patients. The SAS interrater agreement was excellent between the two trained investigators (weighted kappa = 0.93, p <0.001) and between investigators and staff nurses (weighted kappa = 0.85 and 0.87, p <0.001 for both). Conclusion. The SAS is reliable when administered by staff nurses with no experience with it. Due to the paucity of observations of agitated patients, we were unable to determine its validity for assessing agitation.