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. 2022 Apr 8;22(1):102.
doi: 10.1186/s12874-022-01580-2.

The validity, reliability and feasibility of four instruments for assessing the consciousness of stroke patients in a neurological intensive care unit compared

Xiaoxiang Yan #  1   2 , Lingjun Xiao #  3 , Meixin Liao #  3 , Jiajian Huang  3 , Zhijie He  4 , Tiebin Yan  5
Affiliations

The validity, reliability and feasibility of four instruments for assessing the consciousness of stroke patients in a neurological intensive care unit compared

Xiaoxiang Yan et al. BMC Med Res Methodol. .

Abstract

Background: Early rehabilitation is the foundation for recovery for those admitted to an intensive care unit. Appropriate assessment of consciousness is needed before any rehabilitative intervention begins.

Methods: This prospective study compared the validity, reliability and applicability of the sedation-agitation scale, the Richmond Agitation-Sedation Scale, the motor activity assessment scale and the Glasgow Coma Scale in a working neurological intensive care unit. Eighty-three stroke patients were assessed with the four scales by the same 3 raters acting independently: a senior physician, a senior therapist and a trainee. That generated 996 assessment records for comparison.

Results: Good agreement (r=0.98-0.99) was found among the sedation-agitation scale, the Richmond Agitation-Sedation Scale, the motor activity assessment scale scores, but the Glasgow Coma Scale ratings correlated less well (r=0.72-0.76) with the others. Consistent results were also found among the three raters. After stratification of the ratings by age, gender, level of consciousness and Acute Physiology and Chronic Health Evaluation score, the scales reported significant differences among the levels of consciousness and among those with different Acute Physiology and Chronic Health Evaluation results, but not with different age or gender strata.

Conclusions: The four instruments tested are all reliable enough and feasible for use as a tool for consciousness screening in a neurological intensive care unit.

Keywords: Assessment scales; Consciousness; Glasgow Coma Scale; Intensive care; Motor activity assessment scale; Richmond Agitation-sedation Scale; Sedation-agitation scale.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The assessment and data collection schedule of the study. APACHE: Acute Physiology and Chronic Health Evaluation, SAS: Sedation-Agitation Scale, RASS: Richmond Agitation-Sedation Scale, MAAS: Motor Activity Assessment Scale, GCS: Glasgow Coma Scale
Fig. 2
Fig. 2
Study protocol for evaluation with the 4 scales by 3 assessors
See this image and copyright information in PMC

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