Citations 2
Inter-rater Agreement of Richmond Agitation Sedation Scale Assessments in Adult Patients Receiving Mechanical Ventilation in the ICU: A Cross-Sectional Study
Fuchita, Mikita , Pattee, Jack , Le, Dung , To, Teresa , Mucharraz, Carlos , Knippa, Sara, Keyworth, Alexis, Blaine, Caitlin, Le, David, To, Tien, Lindroth, Heidi
Critical Care Explorations | August 28, 2025 | Volume: 7 | Issue: 9 | Pages: e1302
IMPORTANCE: Accurate and reliable sedation assessment is crucial to improving patient outcomes in the ICU. OBJECTIVE: To evaluate the inter-rater agreement and reliability of Richmond Agitation Sedation Scale (RASS) assessments between bedside nurses and trained investigators in patients receiving mechanical ventilation in the ICU. DESIGN, SETTING, AND PARTICIPANTS: An assessor triad, comprising an ICU nurse providing direct patient care and two trained investigators, simultaneously performed RASS assessments during 79 encounters with 62 unique patients receiving mechanical ventilation at two ICUs at a tertiary care academic hospital in Colorado. A total of 58 nurses participated in the study. MAIN OUTCOMES AND MEASURES: The inter-rater reliability of RASS assessments was evaluated with the intraclass correlation coefficient (ICC) and weighted kappa (κ), and inter-rater agreement was evaluated with percentage agreement and Bland-Altman analysis. RESULTS: Acute respiratory failure (55%) and altered mental status (21%) were the most common reasons for mechanical ventilation. Most patients were receiving one (interquartile range, 0.5–2) continuous sedative during the assessment. The inter-rater reliability of RASS assessments between the nurses and investigators (ICC, 0.728–0.779; weighted κ, 0.62–0.63) was lower than between the two investigators (ICC, 0.891; weighted κ, 0.80). The assessor triad agreed on the same RASS values in only 35% of observations. The average differences in RASS were greater between the investigators and nurses, ranging from –0.658 to –0.544, compared with 0.114 between the two investigators. Compared with the mean of the two investigators, RASS values recorded by nurses were more likely to be higher (52% of observations), indicating a lighter sedation level. In 16% of observations, at least one assessor commented on uncertainty or ambiguity with the RASS. CONCLUSIONS AND RELEVANCE: The inter-rater reliability of RASS assessments was high. However, we observed variations in the degree of agreement by assessor category. Further studies are necessary to explore how factors such as assessor characteristics, ICU environment, and patient conditions influence the inter-rater agreement of the RASS in contemporary ICU practices.
A world-wide study on delirium assessments and presence of protocols
Nydahl, Peter , Liu, Keibun , Bellelli, Giuseppe , Calle, Gabi Heras-La, Hoffmann, Magdalena , Jeitziner, Marie‐Madlen , Krewulak, Karla D. , Paulino, Maria Carolina , Haken, Rebecca von , Group, the WDAD Study, Abdalgany, Ahmed Gaber Ahmed, Aburaas, Amjad, Albakosh, Bashir Abobaker, Alhamdan, Hamza Ismail Ahmad, Aljbali, Akram Waled Rajab M, Al-Kandari, Fareeda, Anders, Daniel, Anderson, Marsali, Ashkenazy, Shelly , Avelino, Thiago, Bail, Kasia , Bakri, Ashraf , Baroum, Alaa Mohamed Ali , Brendt-Müller, Jennifer, Brobeil, Angelika, Byrnes, Tru , Cahill, Maria, Canelas, Maria Ana , Carroll, Ida, Conley, Amy, Cotton, Shannon A. , Couser, Mandy, Salgado, A., Cusworth, Elizabeth, Cvoro, Vera , Deosaran, Jordanna, Diebels, Merel, Docherty, Elaine A, Dossow, Vera von , Drennan, Megan, Egdeer, Akram Amin, Eichelsheim, Patrick, Elagili, Aissha Ali Saleh, Elsahl, Saifaleslam Jamal, Elshaikh, Hajer Alsadeg Mohammed, Fathi, Azza , Feige, Melanie, Fiest, Kirsten M. , Fong, Marleta Irene Joy, Fuchita, Mikita , Gaffney, Carol, Vich, Carola Giménez-Esparza, Feldmann, Nicole , Fitzpatrick, Neasa , Fong, Marleta Irene Joy, Goldberg, María Adela , Golüke, Nienke M.S. , Graaf, Marinette van der , Groenewald, Engelina , Gross, Renate , Segers, Camilla Grube, Hadi, Renate, Hamdan, Qusai Ahmad Hasan, Hamida, Bahaeddin Ben, Hamza, Monalyce, Hopkins, Jane , Hopkins, John , Jeyaseelan, Arveen , Kadhim, Ali Jawad, Kohler, S., Kooken, Rens , Khutwah, Ayman Salim Abu, Lange, Puck, Liefrink, Sharon, Lin, Yu‐Min , Loo, Shi Pei , Rodrigues, Sara Beatriz Lopes, MacDonald, Allan S., Madders, G, Massaro, Claudia, Maya, Kerri, Manioudaki, Sofia, Stewart, McKenna, Coimbra, Isabel , Miranda, Teresa, Mohamed, Mohamed A. , Mohammed, Mushin Mohammed Elhadi Agbna, Naeem, Fariha , Nam, Mi-Ryeo, Newman, Elaine, Nicol, Renae, Noonan, Claire, Lopes, Maria Inês, Otmani, Zina , O’Reilly, Susan, Ozorio, Valerie, Palakashappa, Jessica, Pandya, Tej , Papadea, Panagiota, Papanikolaou, Metaxia, Pinardi, Elena , Pereira, Inês Filipa Pinto, Premathilaka, Chirantha , Pop‐Purceleanu, Monica , Puchegger, Marlene, Qalhoud, Nouralddeen Mohammed, Raasing, Maike, Ragheb, Dalia Talaat, Ramadan, Nuri, Rubel, Mushabbir Hossain, Sainsbury, Kate, Schimböck, Florian , Schmädig, Roman , Schoon, Yvonne , Sethia, Deepak , Sextl, Edith, Shah, Bhagyesh , Shaout, Dua’a, Sharabi, Alaa Fouad, Shields, Lynn, Smith, Kendall A. , Dam, Linda Smulders-van, Soiza, Roy L. , Spiegler, Andrea, Stocks, Lucy, Sumerauer, Stefan, Tam, Stephanie , Tan, Aik Haw, Tohsche, Peter, Torres, Raquel Gouveia, Toth, Chantal, Tousgaard, Iben, Vogt, Birgit, Walsh, Erica M., Ward‐Stockham, Kristel , Mart, Melinda Webb‐St, Wijnen-Meijer, Mariajne Elisabeth, Zastrow, Inke , Nydahl, Peter , Jeitziner, Marie-Madlen , Krewulak, Karla D , Benbenishty, Julie Sarah , Boogaard, Mark van den , Caplan, Gideon A. , Chung, Chi Ryang , Elhadi, Muhammed , Gurjar, Mohan , Mailhot, Tanya , Morandi, Alessandro , Nawa, Ricardo Kenji , Oh, Esther S , Collet, Marie Oxenbøll , Lindroth, Heidi , Group, the WDAD Study, Abdelmohsen, Sarah Magdy , Aggar, Christina , Alkandari, Farah, Alkaseek, Akram Mohammed , Anders, Daniel, Anderson, Marsali, Blackwood, Bronagh , Brendt-Müller, Jennifer , Burke, Richard, Cacciatore, Stefano , Cahill, Maria, Conley, Amy, Costello, Maria , Diebels, Merel, Elshaikh, Hajer Alsadeg Mohammed, Emme, Christina , Exl, Matthias Thomas , Fong, Marleta Irene Joy, Gaffney, Carol, Fitzgerald, Rachel, Fong, Marleta Irene Joy, Graaf, Mirjam, Segers, Camilla Grube, Hadi, Renate, Hamdan, Qusai, Hetland, Breanna , Hopkins, Jane Adele, Ibrahim, Said A. , Imbrìaco, Guglielmo , Inoue, Shigeaki , Kadhim, Ali Jawad, Kohler, Sabrina, Korompeli, Anna , Krüger, Lars , Lange, Puck, Rodrigues, Sara Beatriz Lopes, MacDonald, Allan, McAndrew, Natalie S. , Mohamed, Mohamed Anwar Abdelsalam, Mohammed, Mushin Mohammed Elhadi Agbna, Mulkey, Malissa , Nakamura, Kensuke , Nam, Mi-Ryeo, Newman, Elaine, Nicol, Renae, Olotu, Cynthia , Ornago, Alice Margherita , O’Reilly, Susan, Penfold, Rose , Pereira, Inês Filipa Pinto, Quinn, Terence J , Raasing, Maike Wm, Rajhans, Prasad Anant , Ramadan, Nuri, Rubel, Mushabbir Hossain, Sainsbury, Kate, Salis, Francesco , Sharabi, Alaa Fouad, Smith, Kendall, Tam, Stephanie, Timmons, Suzanne , Torres, Raquel Gouveia, Tsolaki, Vasiliki , Castro, Roberta Esteves Vieira de , Vogt, Birgit, Walsh, Erica, Wefer, Franziska , Wøien, Hilde , Zazzara, Maria Beatrice
Age and Ageing | June 12, 2024 | Volume: 53 | Issue: 7 | Pages: No page available
Abstract Background Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities. Objective To assess the worldwide use of validated delirium assessment tools and the presence of delirium management protocols. Design Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023. Setting Cross-sectional online survey including hospitals, rehabilitation and long-term facilities. Methods Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers. Results Data from 44 countries, 1664 wards/units and 36 048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol [n = 1094/1664, 66.8%] were more likely to use a validated delirium test than those without a protocol [odds ratio 6.97 (95% confidence interval 5.289–9.185)]. The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions. Conclusion Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium.