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Original Research |

Comparison and Agreement Between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in Evaluating Patients’ Eligibility for Delirium Assessment in the ICUCorrelation of Sedation Scales in Delirium

Babar A. Khan, MD; Oscar Guzman, PharmD; Noll L. Campbell, PharmD; Todd Walroth, PharmD; Jason L. Tricker, MSN, ACNP-BC; Siu L. Hui, PhD; Anthony Perkins, MS; Mohammed Zawahiri, MD; John D. Buckley, MD, MPH; Mark O. Farber, MD; E. Wesley Ely, MD, MPH; Malaz A. Boustani, MD, MPH
Author and Funding Information

From the Indiana University School of Medicine (Drs Khan, Hui, Buckley, Farber, and Boustani), Indianapolis, IN; Department of Pharmacy, Westchester Medical Center (Dr Guzman), Westchester, NY; Regenstrief Institute, Inc (Drs Khan, Campbell, Hui, Zawahiri, and Boustani and Mr Perkins), Indianapolis, IN; Wishard Health Services (Dr Walroth and Mr Tricker), Indianapolis, IN; Indiana University Center for Aging Research (Drs Khan, Campbell, Hui, and Boustani), Indianapolis, IN; Department of Pharmacy Practice, Purdue University College of Pharmacy (Dr Campbell), West Lafayette, IN; Vanderbilt University School of Medicine (Dr Ely), Nashville, TN; and US Department of Veterans Affairs, Tennessee Valley Geriatric Research Education Clinical Center (Dr Ely), Nashville, TN.

Correspondence to: Babar A. Khan, MD, 410 W 10th St, Ste 2000, Indianapolis, IN 46202; e-mail: bakhan@iupui.edu

Financial/nonfinancial disclosures: Dr Boustani has received grant funds from the National Institute on Aging and the National Institutes of Health, grant funds from Forest Pharmaceuticals and Novartis, and serves on the speakers’ bureau for Pfizer Inc and an advisory board for Eli Lilly and Company. All other authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Funding/Support: The study was supported by a grant from the National Institute on Aging [Grant R01AG034205-01A1].


Funding/Support: The study was supported by a grant from the National Institute on Aging [Grant R01AG034205-01A1].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):48-54. doi:10.1378/chest.11-2100
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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.

Conclusion:  Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU.

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