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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.
|
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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