Nurse-Physician Inter-Rater Agreement on The Richmond Agitation Sedation Scale in Critically Ill Infants and Children

Author(s): Masahiro HARAGUCHI

Background: The Richmond Agitation Sedation Scale (RASS) is one the sedation assessment tools recommended for use in the Adult Intensive Care Unit (ICUs). However, no sedation scales have been recommended specifically for pediatric use. Furthermore, sedation assessment in children is difficult due to the immature state of their cognitive and language abilities. We performed a study assessing inter-rater agreement for the RASS among nurses and physicians in our Pediatric ICU (PICU) before adopting this tool for routine use in our department. In this study, I investigated the raters' reliability between physician and nurse on RASS in PICU.

Methods: Patients who were mechanically ventilated in the PICU from January to May 2014 at A Pediatric hospital were enrolled. When evaluating the sedation level, a nurse and physician pair simultaneously scored the patient using the RASS, recording each score separately. Inter-rater agreement was evaluated using the collected data.

Results: During the study period, 133 patients were scored on 445 occasions by nurse-physician pairs. Overall nurse-physician agreement was high, with the Spearman correlation of ρ = 0.914. However, the inter-rater agreement was lower at a RASS of 1 (54%), -2 (80%), and -3 (80%). When the nurses gave RASS scores of -2 to 1, the physicians gave lower scores than the nurses in disagreeing pairs (94%: 16/17).

Conclusions: Overall agreement in the RASS scores between nurses and physicians was high for critically ill infants and children. However, in a certain segment of the score range, physicians tended to give lower scores than nurses.