Al-Taie Sarah F, Fedwi Muzdalifa Mejbel, Merza Mohammed, Alshahrani Mohammad Y, Rekha M M, Kundlas Mayank, Janney J Bethanney, Sahoo Samir, Ridha-Salman Hayder, Khosravi Mohsen
Department of Biotechnology, College of Science, University of Baghdad, Baghdad, Iraq.
Medical Laboratory Techniques Department, College of Health and Medical Technology, University of Al-maarif, Anbar, Iraq.
Sci Rep. 2025 Aug 6;15(1):28782. doi: 10.1038/s41598-025-14421-1.
This study evaluated the inter-rater reliability and diagnostic validity of different sedation scales for COVID-19 patients in the ICU, focusing on optimizing patient management and outcomes amidst unique pathophysiological challenges. Seventy-three mechanically ventilated COVID-19 patients sedated with intravenous ketamine (10-20 µg/kg/min) were evaluated at Ali Ibn Abi Talib Hospital, Zahedan, Iran, in 2022 and 2023. The sample size was calculated to detect significant differences with a 95% confidence level. Data collection included demographic information and four sedation scales: Riker Sedation-Agitation Scale, Motor Activity Assessment Scale, Richmond Agitation-Sedation Scale, and Ramsay Sedation Scale. The primary outcome measure was inter-rater reliability, quantified by Cohen's Kappa coefficients. Diagnostic validity (criterion validity) was examined by comparing scale scores across demographic and clinical variables. Statistical analyses included the Friedman test, Kappa statistics, and independent T-tests. The study involved patients with a mean age of 56.5 ± 14.1 years, ranging from 37 to 66 years, with 67.1% being male (n = 49) and 32.9% female (n = 24). The Friedman test showed no significant differences in sedation scores among raters or scales (p-values: Riker Sedation-Agitation Scale = 0.89, Motor Activity Assessment Scale = 0.67, Richmond Agitation-Sedation Scale = 0.76, Ramsay Sedation Scale = 0.81). Inter-rater reliability was high across all scales, with Kappa coefficients ranging from 0.71 to 0.89. Criterion validity analysis indicated no significant differences in sedation scores based on age, gender, ICU stay duration, or presence of comorbidities (all p > 0.05). These findings indicate that current sedation scales offer consistent evaluations for ICU COVID-19 patients, unaffected by rater bias or background factors. This reliability in clinical settings suggests their effective use for consistent patient assessments, potentially enhancing outcomes.
本研究评估了重症监护病房（ICU）中用于新型冠状病毒肺炎（COVID-19）患者的不同镇静量表的评分者间信度和诊断效度，重点是在独特的病理生理挑战中优化患者管理和治疗结果。2022年和2023年，在伊朗扎黑丹的阿里·伊本·阿比·塔利卜医院对73例接受静脉注射氯胺酮（10 - 20µg/kg/min）镇静的机械通气COVID-19患者进行了评估。计算样本量以检测95%置信水平下的显著差异。数据收集包括人口统计学信息和四种镇静量表：里克尔镇静 - 躁动量表、运动活动评估量表、里士满躁动 - 镇静量表和拉姆齐镇静量表。主要结局指标是评分者间信度，通过科恩卡方系数进行量化。通过比较不同人口统计学和临床变量的量表评分来检验诊断效度（标准效度）。统计分析包括弗里德曼检验、卡方统计和独立t检验。该研究纳入的患者平均年龄为56.5±14.1岁，年龄范围为37至66岁，其中67.1%为男性（n = 49），32.9%为女性（n = 24）。弗里德曼检验显示，评分者或量表之间的镇静评分无显著差异（p值：里克尔镇静 - 躁动量表 = 0.89，运动活动评估量表 = 0.67，里士满躁动 - 镇静量表 = 0.76，拉姆齐镇静量表 = 0.81）。所有量表的评分者间信度都很高，卡方系数范围为0.71至0.89。标准效度分析表明，基于年龄、性别、ICU住院时间或合并症的存在情况，镇静评分无显著差异（所有p>0.05）。这些发现表明，当前的镇静量表为ICU中的COVID-19患者提供了一致的评估，不受评分者偏差或背景因素的影响。这种在临床环境中的可靠性表明它们可有效地用于一致的患者评估，可能改善治疗结果。
