Original Articles
Vol. 42 No. 3 (2025)
Translation and reliability of the Richmond Agitation-Sedation Scale in an Italian neurological intensive care unit: a pilot study
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 5 February 2025
Accepted: 9 March 2025
Accepted: 9 March 2025
300
Views
266
Downloads
Authors
Introduction: among patients with acquired brain injuries, agitation is a frequent behavioral problem, which often requires the use of sedation. The Richmond Agitation-Sedation Scale (RASS) is commonly used to assess the level of alertness and agitated behavior in critically ill patients. The aims of this study were to translate the RASS into Italian and to test its interrater reliability among sedated patients in an Italian neurological Intensive Care Unit (nICU).
Materials and Methods: a translation (I-RASS) of the RASS from English into Italian was carried out. The inter-rater reliability testing was conducted in an Italian nICU. From May 2022 to October 2024, 21 sedated patients were included and evaluated using the I-RASS by four investigators; the inter-rater reliability was tested using intraclass correlation coefficient (ICC) and Fleiss’ kappa statistics.
Results: the I-RASS was found to be satisfactory and well applicable in a nICU. When tested for inter-rater reliability, ICC and Fleiss’ kappa were compatible with a substantial agreement among investigators (ICCs = 0.9786; ICCa = 0.9946; k=0.769). In addition, a post-hoc analysis on traumatic brain injury (TBI) patients was performed.
Conclusions: the I-RASS, showing excellent inter-rater reliability values, can be useful for sedation and agitation assessment purposes in Italian nICUs.
Downloads
Download data is not yet available.
Citations
1- Hoover GL, Whitehair VC. Agitation after traumatic brain injury: a review of current and future concepts in diagnosis and management. Neurol Res 2023;45:884-92.
2- van der Naalt J, van Zomeren AH, Sluiter WJ, Minderhoud JM. Acute behavioural disturbances related to imaging studies and outcome in mild-to-moderate head injury. Brain Inj 2000;14:781-8.
3- Oddo M, Crippa IA, Mehta S, et al. Optimizing sedation in patients with acute brain injury. Crit Care 2016;20:128.
4- Dolmans RGF, Nahed BV, Robertson FC, et al. Practice-pattern variation in sedation of neurotrauma patients in the intensive care unit: an international survey. J Intensive Care Med 2023;38:1143-50.
5- Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974;2:656-9.
6- Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999;27:1325-9.
7- Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-44.
8- Sessler CN, Riker RR, Ramsay MA. Evaluating and monitoring sedation, arousal, and agitation in the ICU. Semin Respir Crit Care Med 2013;34:169-78.
9- Olson D, Lynn M, Thoyre SM, Graffagnino C. The limited reliability of the Ramsay scale. Neurocrit Care 2007;7:227-31.
10- Rojas-Gambasica JA, Valencia-Moreno A, Nieto-Estrada VH, et al. Validación transcultural y lingüística de la escala de sedación y agitación Richmond al español. Rev Colomb Anestesiol 2016;44:216-21.
11- Chanques G, Jaber S, Barbotte E, et al. Validation de l'échelle de vigilance-agitation de Richmond traduite en langue française [Validation of the french translated Richmond vigilance-agitation scale]. Ann Fr Anesth Reanim 2006;25:696-701. French.
12- Almgren M, Lundmark M, Samuelson K. The Richmond Agitation-Sedation Scale: translation and reliability testing in a Swedish intensive care unit. Acta Anaesthesiol Scand 2010;54:729-35.
13- Nassar Junior AP, Pires Neto RC, de Figueiredo WB, Park M. Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients Sao Paulo Med J 2008;126:215-9.
14- Stasevic K, Stasevic M, Jankovic S, et al. The validation and inter-rater reliability of the Serbian translation of the Richmond agitation and sedation scale in post anesthesia care unit patients. Hippokratia 2016;20:50-54.
15- Ogrinc G, Davies L, Goodman D, et al. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2016;25:986-92.
16- Wild D, Grove A, Martin M, et al. Principles of good practice for the translation and cultural adaptation process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 2005;8:94-104.
17- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-4.
18- Rappaport M, Hall KM, Hopkins K, et al. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil 1982;63:118-23.
19- Hagen C, Malkmus D, Durham P. Levels of cognitive functions. In: Hagen C, Malkmus D, Durham P, editors. Rehabilitation of the Head-Injured Adult: Comprehensive Physical Management. Professional Staff Association Rancho, Los Amigos Hospital; 1979.
20- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.
21- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.
22- Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15:155-63. Erratum in: J Chiropr Med 2017;16:346.
23- Spearman C. The proof and measurement of association between two things. By C. Spearman, 1904. Am J Psychol 1987;100:441-71.
24- rBiostatistic.com. Accessed on 18.11.2024. Available from: https://rbiostatistics.com/
25- sedaICU. Quadro sinottico scale di sedazione - 20ott11. Accessed on 22.11.2024. Available from: http://www.sedaicu.it/it/documenti/109-quadro-sinottico-scale-di-sedazione-20ott11/file
26- Martin J, Heymann A, Bäsell K, et al. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version. Ger Med Sci 2010;8:Doc02.
27- Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003;289:2983-91.
28- Pun BT, Gordon SM, Peterson JF, et al. Large-scale implementation of sedation and delirium monitoring in the intensive care unit: a report from two medical centers. Crit Care Med 2005;33:1199-205.
29- Robinson D, Thompson S, Bauerschmidt A, et al. Dispersion in scores on the richmond agitation and sedation scale as a measure of delirium in patients with subdural hematomas. Neurocrit Care 2019;30:626-34.
30- Wang Z, Winans NJ, Zhao Z, et al. Agitation following severe traumatic brain injury is a clinical sign of recovery of consciousness. Front Surg 2021;8:627008.
How to Cite
Translation and reliability of the Richmond Agitation-Sedation Scale in an Italian neurological intensive care unit: a pilot study. (2025). Scenario® - Il Nursing Nella Sopravvivenza, 42(3). https://doi.org/10.4081/scenario.2025.627
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.