Translation and reliability of the Richmond Agitation-Sedation Scale in an Italian neurological intensive care unit: a pilot study

Introduction: among patients with acquired brain injuries, agitation is a frequent behavioral problem, which often requires the use of sedation. The Richmond Agitation-Sedation Scale (RASS) is commonly used to assess the level of alertness and agitated behavior in critically ill patients. The aims of this study were to translate the RASS into Italian and to test its interrater reliability among sedated patients in an Italian neurological Intensive Care Unit (nICU). Materials and Methods: a translation (I-RASS) of the RASS from English into Italian was carried out. The inter-rater reliability testing was conducted in an Italian nICU. From May 2022 to October 2024, 21 sedated patients were included and evaluated using the I-RASS by four investigators; the inter-rater reliability was tested using intraclass correlation coefficient (ICC) and Fleiss’ kappa statistics. Results: the I-RASS was found to be satisfactory and well applicable in a nICU. When tested for inter-rater reliability, ICC and Fleiss’ kappa were compatible with a substantial agreement among investigators (ICCs = 0.9786; ICCa = 0.9946; k=0.769). In addition, a post-hoc analysis on traumatic brain injury (TBI) patients was performed. Conclusions: the I-RASS, showing excellent inter-rater reliability values, can be useful for sedation and agitation assessment purposes in Italian nICUs.