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Comparative evaluation of SBS and RASS for sedation assessment in mechanically ventilated children
1Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents' Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China.
Insights
The Richmond Agitation-Sedation Scale (RASS) demonstrates strong agreement with the State Behavioral Scale (SBS) for assessing sedation in mechanically ventilated children. RASS offers a practical and efficient alternative for pediatric intensive care unit (PICU) settings.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Assessment Tools
- Sedation Management
Background:
- Assessing analgesia, sedation, and delirium in mechanically ventilated children in the PICU often involves multiple instruments, increasing complexity and nursing workload.
- Standardized and efficient assessment tools are crucial for optimal patient care in the PICU.
Purpose of the Study:
- To evaluate the association and clinical agreement between the State Behavioral Scale (SBS) and the Richmond Agitation-Sedation Scale (RASS).
- To determine if RASS can serve as a practical alternative for sedation assessment in mechanically ventilated pediatric patients.
Main Methods:
- A retrospective study analyzed 13,736 paired SBS and RASS observations from 1,025 mechanically ventilated children in a tertiary PICU.
- Statistical analyses included Spearman rank correlation, linear weighted kappa, and generalized estimating equations (GEE) to account for patient-level clustering.
- A nurse survey assessed the perceived convenience and clinical utility of RASS compared to other instruments.
Main Results:
- A strong positive association was found between RASS and SBS scores (r=0.857, p<0.001).
- Good clinical agreement was demonstrated between the scales (weighted kappa=0.821).
- Nurses found RASS more convenient and faster to use (64.7%) and more reflective of clinical status (54.9%).
Conclusions:
- The Richmond Agitation-Sedation Scale (RASS) shows good clinical agreement with the State Behavioral Scale (SBS) in mechanically ventilated children.
- RASS may be a practical and efficient alternative for sedation assessment in the PICU.
- Standardized training and implementation procedures are recommended for RASS utilization.
Background:
In mechanically ventilated children in the PICU, assessment of analgesia, sedation, and delirium often requires multiple instruments, which increases workflow complexity and nursing burden.
Objective:
To evaluate the association and clinical agreement between the State Behavioral Scale (SBS) and the Richmond Agitation-Sedation Scale (RASS) in mechanically ventilated children in the PICU.
Methods:
This retrospective study included 1,025 mechanically ventilated children admitted to a tertiary PICU between May 2024 and October 2025. SBS and RASS scores were recorded simultaneously at predefined time points, resulting in 13,736 paired observations. Patient-level clustering caused by repeated measurements was addressed using cluster-robust standard errors and generalized estimating equations (GEE).
Results:
Spearman rank correlation analysis with patient-level cluster-robust standard errors showed a strong positive association between RASS and SBS scores (r = 0.857, 95% CI: 0.841-0.873, p < 0.001). Linear weighted kappa demonstrated good agreement (weighted kappa = 0.821, 95% CI: 0.802-0.840), and the GEE-adjusted robust coefficient remained stable (0.849, 95% CI: 0.833-0.865, p < 0.001). In a nurse survey, 64.7% reported that RASS was more convenient and faster to use, and 54.9% considered it more reflective of clinical status.
Conclusions:
RASS showed good clinical agreement with SBS in mechanically ventilated children and may serve as a practical and efficient alternative for sedation assessment in the PICU, provided that standardized training and local implementation procedures are ensured.
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