Reaction Level Scale

Abstract: The Reaction Level Scale (RLS 85) is a “coma scale” for the direct assessment of overall reaction level in patients with acute brain disorders. It is devised for reliable use even in the management of patients who are difficult to assess, such as intubated patients and patients with swollen eyelids. We here present the manual of the RLS 85 and the guidelines for its use. The underlying concepts as well as limitations are outlined. Condensed information of known reliability and validity is presented. A training scheme for presumed observers (doctors, nurses and assistant nurses) is outlined. It is suggested that users of the RLS 85 refer to these guidelines and in scientific reports clearly state any deviations from this present manual in order to facilitate valid comparisons between different studies and different groups of patients.

Abstract: The Glasgow Coma Scale (GCS) is a well-known source of error in outcome prediction models We compared assessment of cerebral responsiveness with the GCS and the Reaction Level Scale (RLS) in two otherwise similar outcome prediction models Prospective, observational study in a general intensive care unit All admissions of patients with or at risk of developing impaired brain function between 1997 and 1998 (n=534) Admissions were scored by RLS and APACHE II (includes scoring with the GCS) The RLS scores were transformed to APACHE II central nervous system scores according to a predetermined protocol APACHE II estimated probability of death was calculated conventionally with the GCS and the RLS Vital status 90 days after admission was secured from a national database Bias and precision was 05% and 166%, respectively The area under receiver operating characteristic curves was slightly but significantly greater with the RLS-based APACHE II model than with the GCS-based model (092 vs 090) Discrimination was improved primarily in admissions with low and intermediate probability of death Scoring of cerebral responsiveness with the RLS instead of the GCS was associated with minimal bias of the APACHE II probability of death estimate Assessment of consciousness in critically ill with the RLS deserves further evaluation

Abstract: A new scale for assessment of overall responsiveness, the Reaction Level Scale (RLS 85), which has been shown to have better reliability than the Glasgow Coma Scale (GCS), has been tested in four neurosurgical departments regarding inter-observer agreement and coveragei. e. the proportion of patients that could be assessed by the scale. In a carefully designed study 51 observers pairwise performed 164 tests on 88 patients. Reliability was studied by the Kappa method, which is defined as inter-observer agreement corrected for agreement by chance. The inter-observer agreement measured as overall Kappa was good (K=0.69 ±0.05) and there were no significant differences between the departments, professional categories or aetiologies. Regarding the separate RLS 85 levels the Kappa values were above 0.65, except for withdrawing (K=0.51) and flexor responses (K=0.55). There was good inter-observer agreement on coma (K=0.71). In conclusion, the RLS 85 proved to be easily learnt, it showed full coverage without pseudoscoring, and it was used in a consistent way by doctors, nurses and assistant nurses of four different neurosurgical departments in two Scandinavian countries.

Abstract: The Glasgow Coma Scale (GCS) and the Swedish Reaction Level Scale (RLS85), two level-of-consciousness scales used in the assessment of patients with head injury, were compared in a prospective study of 239 patients admitted to a regional head injury unit over a 4-month period. Assessments were made by nine staff members ranging from house officer to registrar, after briefing about the two scales. Data were also collected on age, nature of injuries, surgical treatment, and condition at discharge or transfer using the Glasgow Outcome Scale. Both the GCS and the RLS85 reliably identified comatose patients and those with minor head injury, but were much less effective in defining the response level in patients considered to have a moderate head injury. Only 41% of the patients allocated to a moderate-head-injury category by the GCS and the RLS85 were common to both groups. Where a mismatch occurred, neither scale allocated patients to a 'better' or 'worse' category more frequently than the other. Assessment o...