Frontiers in pediatrics · 2026
Comparative evaluation of SBS and RASS for sedation assessment in mechanically ventilated children.
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Li Dan, He Shan, Li Qi, Shen Jie, Tang Ping
Аннотация
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.
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.