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American Journal of Critical Care. 2009;18: 118-121 doi:10.4037/ajcc2009368
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Interrater Variability of a Severity-of-Illness Score in Critically Ill Adults

By April D. Miller, PharmD, Pam Branson, RN, MSN, P. Shane Winstead, PharmD and David M. Hiestand, MD, PhD. April D. Miller is a clinical assistant professor in the South Carolina College of Pharmacy, University of South Carolina Campus, Columbia. At the time of the study, Dr Miller was a critical care pharmacy resident in the Department of Pharmacy Services at University of Kentucky Health-Care, Lexington. Pam Bransonis a nursing patient care facilitator and David M. Hiestandis an assistant professor of medicine and pediatrics in the Division of Pulmonary, Critical Care, and Sleep Medicine at University of Kentucky HealthCare, Lexington. P. Shane Winsteadis a pharmacy specialist in the medical intensive care unit at University of Kentucky HealthCare, Lexington.

Corresponding author: April D. Miller, PharmD. South Carolina College of Pharmacy-USC Campus, Coker Life Sciences, 715 Sumter St, Columbia, SC 29208 (e-mail: millerad{at}sccp.sc.edu).

Background Critically ill patients often require sedation and analgesia. Scales have been developed to provide clinicians with sedation targets. Daily interruption of continuous infusions of sedatives and sedation protocols improve patients’ outcomes. However, perceived instability of a patient’s condition can prevent implementation of appropriate sedation targets and daily interruption of sedation.

Objective To evaluate the interrater variability of a severity-of-illness score developed to help nurses determine patient-specific sedation targets and identify candidates for daily interruption of sedation.

Methods The severity-of-illness score was implemented as part of an institutional protocol, and bedside nurses in the medical intensive care unit were taught how to determine and use the score. Bedside nurses recorded the score daily in patients’ medical records. For study purposes, a study nurse who made rounds with the medical team and a pulmonary/critical care fellow physician also independently determined the score.

Results A total of 38 assessments of severity-of-illness scores in 10 different patients were made during the study period. For the 24 assessments made by all 3 observers, the {kappa} coefficient for agreement for the severity-of-illness score was 0.58.

Conclusions The severity-of-illness score had good interrater variability as a tool for determining sedation targets and identifying candidates for daily interruption of sedation. Future study on how use of the score affects sedative dosing and outcomes is needed.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Identify potential problems for critically ill patients whose sedation and analgesia are not properly managed.
  2. Examine severity-of-illness score and its potential for use in the critical care area.
  3. Evaluate this study for its value in clinical practice.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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Copyright © 2009 by the American Association of Critical-Care Nurses.