Starmark et al developed the Reaction Level Scale (RLS85) to evaluate the neurologic status of patients after head trauma, neurosurgery or other injury to the central nervous system (CNS). This can be used to monitor a patient over time. The authors are from the University of Goteborg in Sweden.
Clinical Status
Level
alert, with no delay in response (responds without stimulus)
1
drowsy or confused, but responds to light stimulation
2
very drowsy or confused, but responds to strong stimulation
3
unconscious; localizes (moves a hand towards) a painful stimulus but does not ward it off
4
unconscious; makes withdrawing movements following a painful stimulus
5
unconscious; stereotypic flexion movements following painful stimuli
6
unconscious; stereotypic extension movements following painful stimuli
7
unconscious; no response to painful stimuli
8
where:
• I wonder if there is any benefit to having a level 2.5 for response to moderate stimulus.
• Stereotypic flexion responses include flexing both arms at the elbows, with flexed wrists over the chest.
A patient is considered mentally responsive with levels 1 to 3.
A patient is considered mentally unresponsive with levels 4 to 8.
Performance:
• The RLS85 was shown to have better interobserver agreement than the Glasgow Coma Scale.
• The RLS85 shows better "coverage", especially in intubated patients.
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