Sedation assessment tool to score acute behavioural disturbance in the emergency department

Abstract

The objective of the study was to evaluate the effectiveness of the sedation assessment tool (SAT) in assessing patient response to treatment for acute behavioural disturbance (ABD). The SAT is a simplified version of the altered mental status score (AMSS) and is a 7-point scale assessing levels of agitation and sedation using only two descriptors. To assess the SAT we firstly compared plots of the SAT and the AMSS versus time in patients with ABD recruited to a clinical trial. AMSS were converted to the SAT for this comparison. Second, the sensitivity and specificity were calculated for an increase in the SAT to +2 or +3 as a predictor of whether additional sedation was required in a prospective cohort of 138 patients. Third, interrater reliability was assessed using two individuals to score the same patient at two different time points and finally the time to record the score was measured. Plots of AMSS and SAT for 91 patients in the clinical trial illustrated similar trends in agitation/sedation. Seventeen of 138 patients in the second cohort had an increase in the SAT. Fifteen of 17 (88%) received additional sedation. The sensitivity and specificity of the SAT for additional sedation was 100% (95% CI 75-100%) and 98% (95% CI 94-100%), respectively. The median time for staff to assign the SAT was 10 s (range 3-15 s). Interrater reliability was high with a kappa of 0.87. The SAT is a simple, rapid and useful measure of the level of agitation/sedation in patients with ABD. Increases in the score reliably indicated the need for further sedation.