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The Reaction Level Scale (RLS 85)

Manual and guidelines

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Summary

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.

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References

  1. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders. Third Edition, Revised. American Psychiatric Association, Washington, DC, pp 100–103

    Google Scholar 

  2. Braakman R, Avezaat CJJ, Maas AIR, Roel M, Schouten HJA (1977) Interobserver agreement in the assessment of the motor response of the Glasgow Coma Scale. Clin Neurol Neurosurg 80: 100–106

    PubMed  Google Scholar 

  3. Brihaye J, Frowein RA, Lindgren S, Loew F, Stroobrandt G (1978) Report on the Meeting of the W.F.N.S. Neuro-Traumatology Committee, Brussels, 19–23 September 1976. Acta Neurochir (Wien) 40: 181–186

    Google Scholar 

  4. Freemon FR (1981) Organic mental disease. MTP Press Ltd, Lancaster, England, pp 81–84

    Google Scholar 

  5. Guildford JP (1975) Psychometric methods. Tata McGraw-Hill edition, Haryana, pp 278–280

    Google Scholar 

  6. Halsey JA, Downie AW (1966) Decerebrate rigidity with preservation of consciousness. J Neurol Neurosurg Psychiatry 29: 350–355

    PubMed  Google Scholar 

  7. Holmgren E, Lindgren S, Stålhammar D (1981) Multiple or single scales in observation at bedside. Acta Neurochir (Wien) 56: 141–142

    Google Scholar 

  8. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet i: 480–484

    Google Scholar 

  9. Jennett B, Teasdale G (1977) Aspects of coma after severe head injury. Lancet i: 878–881

    Google Scholar 

  10. Langfitt TW (1979) Comment on: Jennett B, Teasdale G, Braakman R, Minderhoud J, Heiden J, Kurze T. Prognosis of patients with severe head injury. Neurosurgery 4: 283–289

    PubMed  Google Scholar 

  11. Levy DE, Bates D, Caronna JJ, Cartlidge NEF, Knill-Jones RP, Lapinski RH, Singer BH, Shaw DA, Plum F (1981) Prognosis in nontraumatic coma. Ann Intern Med 94: 293–301

    PubMed  Google Scholar 

  12. Lindqvist G (1966) Mental changes after transsphenoidal hypophysectomy. Acta Psychiatr Scand 42 [Suppl] 190: pp 150

    Google Scholar 

  13. Lindqvist G, Malmgren H (1986) Organisk Psykiatri. Vetenskaps-teoretiska och kliniska aspekter. Filosofiska Meddelanden, Röda Serien No 26, University of Göteborg, Göteborg, pp 61–73

    Google Scholar 

  14. Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 [Suppl] 149: 140–141

    Google Scholar 

  15. Medical Research Council, Brain Injuries Committee (1941) A glossary of psychological terms commonly used in'cases of head injury. Medical Research Council War Memorandum No 4, HSMO, London

    Google Scholar 

  16. Miller JD, Teasdale GM (1985) Clinical trials for assessing treatment for severe head injury. In: Becker DP, Povlishock JT (eds) Central nervous system trauma. Status Report 1985. NIH, Washington, pp 17–32

    Google Scholar 

  17. Plum F, Posner JB (1980) The diagnosis of stupor and coma. 3rd edition. FA Davies Company, Philadelphia

    Google Scholar 

  18. Price DJ (1986) Factors restricting the use of coma scales. In: Lindgren S (ed) Modern concepts in neurotraumatology. Acta Neurochir (Wien) [Suppl] 36: 106–111

  19. Simpson CJ (1984) Doctors and nurses use of the word confused. Br J Psychiatry 145: 441–443

    PubMed  Google Scholar 

  20. Stanczak DE, White III JG, Gouview WD, Moehle KA, Daniel M, Novack T, Long CJ (1984) Assessment of level of consciousness following severe neurological insult. J Neurosurg 60: 955–960

    PubMed  Google Scholar 

  21. Starmark J-E, Heath A (1988) Severity grading in self-poisoning. Submitted for publication

  22. Starmark J-E, Holmgren E, Stålhammar D (1982) Estimation of reaction levels in coma patients. ICRAN, Edinburgh

    Google Scholar 

  23. Starmark J-E, Stålhammar D, Holmgren E, Rosander B (1987) Assessment of responsiveness in acute cerebral disorders. A comparison between the Glasgow Coma Scale and the Reaction Level Scale (RLS 85). Submitted for publication

  24. Starmark J-E, Holmgren E, Stålhammar D (1987) Assessment of reponsiveness in acute cerebral disorders. A critical survey of current reporting with special reference to the Glasgow Coma Scale. Submitted for publication

  25. Starmark J-E, Lindgren S (1986) Possible mechanisms of “vegetative state”. In: Lindgren S (ed) Modern concepts in neurotraumatology. Acta Neurochir (Wien) [Suppl] 36: 121–122

  26. Stålhammar D, Starmark J-E (1986) Assessment of responsiveness in head injury patients. In: Lindgren S (ed) Modern concepts in neurotraumatology. Acta Neurochir (Wien) [Suppl] 36: 91–94

  27. Stålhammar D, Starmark J-E, Holmgren E, Eriksson N, Nordström CH, Fedders O, Rosander B (1988) Assessment of responsiveness in acute cerebral disorders. A multicentre study on the Reaction Level Scale (RLS 85). Acta Neurochir (Wien) 90: 73–80

    Google Scholar 

  28. Teasdale G, Jennett B (1976) Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 35: 45–55

    Google Scholar 

  29. Åsberg M, Perris C, Schalling D, Sedvall G (1978) The CPRS—development and applications of a psychiatric rating scale. Acta Psychiatr Scand [Suppl] 271

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Starmark, J.E., Stålhammar, D. & Holmgren, E. The Reaction Level Scale (RLS 85). Acta neurochir 91, 12–20 (1988). https://doi.org/10.1007/BF01400521

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