Article : A New Pediatric Sedation State Scale

Katherine Bakes, MD reviewing Cravero JP et al. Pediatrics 2017 May.

This easy-to-learn 6-point scale was developed to assess the quality or “state” of sedation experienced by children undergoing procedural sedation.

Investigators developed a simple scale to evaluate quality — as opposed to depth — of sedation experienced by pediatric patients undergoing any type of sedation (pharmacologic or nonpharmacologic) for diagnostic or therapeutic procedures. Quality was assessed by the overall condition of the patient, including any experience of pain, anxiety, change in level of consciousness, and adverse events. The 6-point Pediatric Sedation State Scale (PSSS) was developed and informed by American Academy of Pediatrics and American Society of Anesthesiologists defined sedation states and nine procedural sedation experts. The six activity states are as follows:

State 5: Movement impedes procedure and requires forceful immobilization

State 4: Movement requires gentle immobilization for positioning

State 3: Facial expression of pain or anxiety

State 2: Quiet, not moving, no frown, no verbalization of complaint (ideal state)

State 1: Deeply asleep with normal vital signs, but requires airway intervention or assistance (e.g., central or obstructive apnea)

State 0: Deeply asleep with abnormal physiologic parameters that require acute intervention (e.g., O2 saturation <90%, hypotension, bradycardia)

After a 10-minute training session, 20 sedation providers in various specialties and with different levels of training and experience each used the PSSS to score 13 procedural sedation video clips. The results demonstrated excellent intrarater and interrater reliability. The PSSS correlated well with another sedation scale used to measure pediatric distress associated with medical procedures, the Observational Scale of Behavioral Distress-revised.


Cravero JP et al. Validation of the Pediatric Sedation State Scale. Pediatrics 2017 May; e20162897.