State Behavioral Scale (SBS)
State Behavioral Scale (SBS) for the assessment of sedation levels in pediatric patients
The State Behavioral Scale was developed by Dr. Martha Curley in collaboration with Sion K. Harris, Karen Fraser, Rita Johnson, and John Arnold.
The State Behavioral Scale was developed by Dr. Martha Curley in collaboration with Sion K. Harris, Karen Fraser, Rita Johnson, and John Arnold.
Permission to use the SBS
You are free to reproduce and use the State Behavioral Scale (SBS), without modification, for research or clinical practice. The SBS may be reproduced on forms with hospital or clinical unit letterhead or logos, or used in electronic record systems. Please cite: Curley, M. A. Q., Harris, S. K., Fraser, K., Johnson, R., & Arnold, J. H. (2006). State behavioral scale: A sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatric Critical Care Medicine, 7(2), 107-114.
The SBS may not be used for commercial purposes or monetized without the express written permission from Dr. Martha A.Q. Curley. Permission requests should be made in writing to Dr. Curley: MAQCurley@gmail.com.
Requests to translate the SBS into another language should be made in writing to Dr. Curley: MAQCurley@gmail.com. Forward and back translations must be certified for accuracy. Any translations must be made freely available for research or clinical practice. Translations may not be used for commercial purposes or monetized without the written permission from Dr. Martha A.Q. Curley.
The SBS may not be used for commercial purposes or monetized without the express written permission from Dr. Martha A.Q. Curley. Permission requests should be made in writing to Dr. Curley: MAQCurley@gmail.com.
Requests to translate the SBS into another language should be made in writing to Dr. Curley: MAQCurley@gmail.com. Forward and back translations must be certified for accuracy. Any translations must be made freely available for research or clinical practice. Translations may not be used for commercial purposes or monetized without the written permission from Dr. Martha A.Q. Curley.
State Behavior Assessment Guidelines
Every intubated patient should have their state behavior assessed and documented at least every four hours.
Pediatric Assessment:
State behavior assessment, especially in preverbal or nonverbal children, is challenging. The nurse should tailor sedation assessment to the patient’s developmental level, medical status and temperament using the SBS.
Definition of State Behavior:
In pediatric patients supported on mechanical ventilation, state behavior is described as a summative characteristic of the following dimensions:
1. Respiratory Drive/ Response to ventilation
2. Coughing
3. Best Response to Stimulation
4. Attentiveness to Care Provider
5. Tolerance to Care
6. Consolability
7. Movement after Consoled
Note that the SBS may be used in pediatric patients not supported on mechanical ventilation, considering the patient’s respiratory drive, best response to stimulation, attentiveness to care provider, tolerance to care, consolability and movement after consoled. The SBS can also be used to describe the patients’ level of sedation when using pediatric delirium scales.
Assessment/Documentation:
Assess and document the patient’s state behavior in the designated column of the Patient Care Flowsheet:
Description:
The SBS is a 6-point scale that describes state behavior on a scale of -3 to +2. (anesthesia to agitation)
Assessment Method:
1. Review the SBS, familiarizing yourself with the indicators and how they are scored.
2. Assess the patient during normal cares. Use progressive stimuli to elicit the patient’s response; specifically, using a calm voice call the patient’s name. If no response, call the patient’s name and gently touch the patient’s body. If no response, asses the patient’s response to a planned noxious procedure, e.g., planned endotracheal suctioning. If a noxious procedure is not planned and assessment is critically important then, using a pencil/pen, provide < 5 seconds of direct pressure to the patient’s nail bed.
Scoring Method:
Observe the patient’s respiratory drive/response to ventilation, coughing, best response to stimulation, attentiveness to care provider, tolerance to care, consolability and movement after consoled then assign a score from -3 to +2 that best describes the patient’s state.
Interpretation:
More negative scores reflect a sedated state. More positive scores reflect a more agitated state. Zero scores reflect a patient who is awake and able to be calmed. Clinical judgment is used to interpret state behavior considering the context of the situation to differentiate behavioral distress from pain behavior.
Pediatric Assessment:
State behavior assessment, especially in preverbal or nonverbal children, is challenging. The nurse should tailor sedation assessment to the patient’s developmental level, medical status and temperament using the SBS.
Definition of State Behavior:
In pediatric patients supported on mechanical ventilation, state behavior is described as a summative characteristic of the following dimensions:
1. Respiratory Drive/ Response to ventilation
2. Coughing
3. Best Response to Stimulation
4. Attentiveness to Care Provider
5. Tolerance to Care
6. Consolability
7. Movement after Consoled
Note that the SBS may be used in pediatric patients not supported on mechanical ventilation, considering the patient’s respiratory drive, best response to stimulation, attentiveness to care provider, tolerance to care, consolability and movement after consoled. The SBS can also be used to describe the patients’ level of sedation when using pediatric delirium scales.
Assessment/Documentation:
Assess and document the patient’s state behavior in the designated column of the Patient Care Flowsheet:
- On admission
- Before and after sedative administration or any intervention to decrease or alleviate agitation
- At a minimum of every 4 hours with vital signs
Description:
The SBS is a 6-point scale that describes state behavior on a scale of -3 to +2. (anesthesia to agitation)
Assessment Method:
1. Review the SBS, familiarizing yourself with the indicators and how they are scored.
2. Assess the patient during normal cares. Use progressive stimuli to elicit the patient’s response; specifically, using a calm voice call the patient’s name. If no response, call the patient’s name and gently touch the patient’s body. If no response, asses the patient’s response to a planned noxious procedure, e.g., planned endotracheal suctioning. If a noxious procedure is not planned and assessment is critically important then, using a pencil/pen, provide < 5 seconds of direct pressure to the patient’s nail bed.
Scoring Method:
Observe the patient’s respiratory drive/response to ventilation, coughing, best response to stimulation, attentiveness to care provider, tolerance to care, consolability and movement after consoled then assign a score from -3 to +2 that best describes the patient’s state.
Interpretation:
More negative scores reflect a sedated state. More positive scores reflect a more agitated state. Zero scores reflect a patient who is awake and able to be calmed. Clinical judgment is used to interpret state behavior considering the context of the situation to differentiate behavioral distress from pain behavior.
Downloadable SBS
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Chinese:
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Finnish:
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Japanese:
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Article of InterestCurley, M. A. Q., Harris, S. K., Fraser, K., Johnson, R., & Arnold, J. H. (2006). State behavioral State Behavioral Scale (SBS): A sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatric Critical Care Medicine, 7(2), 107-114. (PMID: 16446601)
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