Clinimetric study and review of the Reaction Level Scale

Abstract

Numerous clinical tools have been used for the assessment of consciousness, with the Glasgow Coma Scale (GCS) 1,2 remaining the gold standard. [3][4][5] The Reaction Level Scale 85 (RLS) 6 was developed to surpass some drawbacks of the GCS, namely low interrater reliability, weak delineation of coma, and insufficient patients' coverage (the extent to which the scale cannot be fully implemented, such as the verbal element in intubated patients). 7 The scale includes 8 single-line steps, each representing a level of responsiveness, with levels ≥4 considered comatose. 6,7 In a modified version of the scale, two subcategories of level 3 were later added (Appendix 1). [8][9][10] Despite that it was initially presented as a "better alternative" to the GCS, the RLS never gained wide acceptance. 11 Further, the reliability and validity of the scale have not been proved yet, and its clinimetric properties have not been studied sufficiently. Since it is still in use in a number of top institutions mainly in Scandinavia, 3,12,13 we aimed to investigate whether there is adequate documentation

Comparison of the prognostic validity of three simplified consciousness assessment scales with the Glasgow Coma Scale

“…AUC values of approximately 0.900 were expected, and the level of difference between them was set at 5%. It was found that 18 subjects for AUC calculations and 84 subjects for comparisons would reach a power of 80% and a 5% level of significance, which were considered appropriate for the purposes of the current study [ 25 , 38 ].…”