2026 Critical Care Congress Skip to main content
2026 Critical Care Congress Main banner
Final Program


Advance Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Session Icons
Thought Leader Session
Thought Leader Session
Guidelines Session
Guidelines Session
Aging Adult Track
Aging Adult Track
Additional Registration Fee
Additional Registration Fee

Research Snapshot Theater: Future of Critical Care, Pediatric I

Rethinking Pediatric Sedation Assessment: A Statistical Evaluation of the State Behavioral Scale

Tuesday, March 24, 2026
8:45 AM - 9:45 AM Central Time
Location: Connections Central - RST 03

  • Sidharth Raghavan, n/a

    Johns Hopkins School of Medicine, Maryland

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • JH

    Jake Hoffmann, n/a

    Maryland

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • MD

    Maryn Day, N/A

    Student
    Department of Biomedical Engineering, Johns Hopkins University

    Disclosure information not submitted.

  • Sayantika Roy, BS (she/her/hers)

    University of Rochester

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • BP

    Barbara Pejic, N/A

    Student
    Department of Biomedical Engineering, Johns Hopkins University

    Disclosure information not submitted.

  • OM

    Olivia Morrissey, N/A

    Student
    Department of Biomedical Engineering, Johns Hopkins University

    Disclosure information not submitted.

  • CM

    Christie Moyer, BSN, RN

    Nurse Practitioner
    Department of Nursing, Johns Hopkins

    Disclosure information not submitted.

  • DY

    Daniel Yao, N/A

    Student
    Department of Biomedical Engineering, Johns Hopkins University

    Disclosure information not submitted.

  • KB

    Kristen Brown, DNP, RN CRNP, CPNP-AC, CHSE-A

    Associate Professor
    Johns Hopkins School of Nursing

    Disclosure information not submitted.

  • ND

    Nicholas Durr, PhD

    Associate Professor
    Department of Biomedical Engineering, Johns Hopkins University

    Disclosure information not submitted.

  • SK

    Sapna Kudchadkar, MD, PhD, FCCM

    Professor
    Johns Hopkins University School of Medicine

    Disclosure information not submitted.

  • JF

    Jim Fackler, MD

    Professor
    Johns Hopkins University School of Medicine, Anesthesiology and Critical Care Medicine

    Disclosure information not submitted.

  • Jessica LaRosa, MD

    Johns Hopkins School of Medicine

    Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Only 58% of critically ill children in the United States are optimally sedated, with sedation-associated adverse events occurring in up to 70% of cases. Sedation-agitation assessment is conducted using validated qualitative scales such as the State Behavioral Scale (SBS) and Richmond Agitation Sedation Scale (RASS) but are subject to significant variability and infrequent measurement. The objective of this study is to evaluate the State Behavioral Scale in assessing patient state and making critical sedation decisions.


Methods: Nine mechanically ventilated, critically ill children were recruited for this pilot study between 2023 and 2025. Patient electronic health record (EHR), continuous waveform vital sign data, and video recordings were obtained. EHR data included nurse-documented SBS scores and all continuous and intermittent analgosedation administered. SBS scores were retrospectively determined using video footage from the patient’s bedside in conjunction with their vitals waveform data. Scoring was performed by a pair of research assistants (M.D., O.M.) trained by a pediatric critical care nurse and physician and validated by a pediatric critical care physician. Retrospective SBS scores were assessed in 30-minute windows, during any patient stimulation, and at time of intermittent analgosedation administration.


Results: In total, 855 hours of video were analyzed, with a mean of 95 hours and 191 retrospective SBS scores per patient. Retrospective SBS scores from patient video (Interrater reliability: Cohen’s kappa 0.775 and 0.873) showed poor agreement with nurse-documented SBS scores: MAE 1.10, RMSE 1.44, Pearson r=0.12, Cohen’s Kappa 0.05. Even in extreme nurse-documented agitation (SBS +2), 100% of retrospective assessments were SBS < +2. Vital signs showed weak correlations with retrospective SBS (Retro: HR: r=0.095, RR: r=0.324). Intermittent analgosedation PRN medication administration was commonly issued when not recommended based on retrospective SBS scores (Spearman rho =-0.021).


Conclusions: The SBS scale demonstrates poor correlation with video sedation assessments, analgosedation medication decisions, and physiological parameters. Objective, data-driven assessment tools are critically needed to validate pediatric sedation decision-making and improve patient care.