Behavioral Activity Rating Scale (BARS)

The Behavioral Activity Rating Scale (BARS) is a single-item, 7-point, clinician-observed rating scale designed to quantify a patient's level of agitation. It provides a quick and reliable method for assessing agitation, particularly in emergency or psychiatric settings, and for monitoring the patient's response to treatment.

When to Use

The BARS is intended for use by healthcare professionals to assess patients exhibiting signs of agitation. It is useful for initial assessment, tracking changes in agitation levels over time, and evaluating the efficacy of interventions aimed at calming the patient.

Scoring and Interpretation

The scale consists of seven distinct behavioral anchor points. The clinician selects the single best description of the patient's state:

A score of 4 is considered a normal level of activity. Scores above 4 indicate increasing levels of agitation, while scores below 4 indicate increasing levels of sedation.

Results

• BARS Score 1-3: Additional medical workup may be needed.
• BARS Score 4: Likely normal behavioral activity, intervention not needed.
• BARS Score 5-6: Indicates the need for verbal de-escalation or other behavioral interventions.
• BARS Score 7: Likely to require pharmacologic intervention and/or physical restraints. May required additional medical workup.

Evidence and Validation

The BARS was validated in a study by Swift et al. (2002) involving patients with acute agitation. The study demonstrated the scale's validity, reliability, and sensitivity to change. Key findings include:

• Inter-rater Reliability: The BARS showed excellent inter-rater reliability (weighted kappa = 0.90), indicating that different clinicians are likely to assign the same score to a patient.
• Concurrent Validity: The BARS was highly correlated with other established measures of agitation, including the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) (r=0.88) and the Clinical Global Impression-Severity of Illness (CGI-S) (r=0.83).
• Sensitivity to Change: The scale was effective in detecting changes in agitation levels following treatment with intramuscular ziprasidone.

The authors concluded that the BARS is a 'valid and reliable, single-item global rating scale of agitation that is quick to administer and sensitive to change.' Its simplicity makes it a practical tool for busy clinical environments.

• Observe the patient's behavior and level of activity.
• Select the one description from the list that best matches the patient's current state.
• The tool will provide the corresponding BARS score, which quantifies the level of agitation.
• BARS can be reassessed at multiple time points after an intervention for agitation.