Ryder-Lewis Michelle C, Nelson Katherine M
Work Health Solutions Ltd., PO Box 48104, Silverstream, Wellington, New Zealand.
Intensive Crit Care Nurs. 2008 Aug;24(4):211-7. doi: 10.1016/j.iccn.2007.11.004. Epub 2008 Feb 21.
This study determined the inter-rater reliability of the Sedation-Agitation Scale (SAS) when used by staff in a tertiary level general intensive care unit (ICU). The study was designed to answer the question in the 'real world', with minimum patient exclusion criteria, do nurses and doctors rate ICU patient's sedation levels using the SAS similarly? A convenient sample of 35 nursing and seven medical staff and a randomly selected sample of 69 patients were used. A nurse and a doctor rated each patient simultaneously using the SAS, with a systematic five-stage arousal process. The results showed that there was exact agreement between the nurses' and doctors' scores in 74% of assessments. The weighted kappa finding of 0.82 indicates very good agreement (reliability). The mean SAS scores recorded for nurses (2.33+/-1.21) and doctors (2.36+/-1.35) were similar. Intraclass correlations for single measures (r=.921, p<.001) and average measures (r=.959, p<.001) indicated individuals who completed multiple ratings did not introduce bias. Where there was a difference between the paired ratings, these were only one level of the SAS away from each other. This research indicates nurses and doctors rate patients' levels of sedation similarly using the SAS. It also provides support for the use of the instrument in general ICUs outside the USA. Research is now needed to determine the value of the SAS in guiding clinical decision-making related to sedation management.
本研究确定了三级综合重症监护病房（ICU）工作人员使用镇静-躁动评分量表（SAS）时的评分者间信度。该研究旨在在“现实世界”中回答这个问题，即采用最少的患者排除标准，护士和医生使用SAS对ICU患者镇静水平的评分是否相似？研究使用了35名护理人员和7名医务人员的便利样本以及69名随机抽取的患者样本。一名护士和一名医生同时使用SAS对每位患者进行评分，采用系统的五阶段唤醒过程。结果显示，在74%的评估中，护士和医生的评分完全一致。加权kappa值为0.82，表明一致性非常好（信度高）。护士（2.33±1.21）和医生（(2.36±1.35)记录的SAS平均评分相似。单项测量的组内相关性（r = 0.921，p < 0. )和平均测量的组内相关性（r = 0.959，p < 0.001）表明，完成多次评分的个体未引入偏差。在配对评分存在差异的情况下，这些差异仅相差SAS的一个等级。本研究表明，护士和医生使用SAS对患者镇静水平的评分相似。这也为该工具在美国以外的普通ICU中的使用提供了支持。现在需要开展研究以确定SAS在指导与镇静管理相关的临床决策中的价值。
