Overview :

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.

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.

Stalhammer D, Starmark JE. Assessment of responsiveness in head injury patients. The Glasgow Coma Scale and some comments on alternative methods. Acta Neurochir. 1986; Supplement 36: 91-94.

Starmark J-E, Stalhammer D, Holmgren E. The reaction level scale (RLS85). Manual and guidelines. Acta Neurochir. 1988; 91: 12-20.

Starmark J-E, Stalhammer D, et al. A comparison of the Glasgow coma scale and the Reaction Level Scale (RLS85). J Neurosurg. 1988; 69: 699-706. (Figure 1, page 701).

Walther SM, Jonasson U, Gill H. Comparison of the Glasgow Coma Scale and the Reaction Level Scale for assessment of cerebral responsiveness in the critically ill. Intensive Care Medicine. 2003; 29: 933-938.