Stålhammar D, Starmark J E, Holmgren E, Eriksson N, Nordström C H, Fedders O, Rosander B
Department of Neurosurgery, University of Göteborg, Sahlgren's Hospital, Sweden.
Acta Neurochir (Wien). 1988;90(3-4):73-80. doi: 10.1007/BF01560558.
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 coverage i.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.
一种用于评估整体反应性的新量表——反应水平量表（RLS 85），已被证明比格拉斯哥昏迷量表（GCS）具有更好的可靠性。该量表在四个神经外科部门就观察者间一致性和覆盖范围（即可以用量表评估的患者比例）进行了测试。在一项精心设计的研究中，51名观察者两两一组对88名患者进行了164次测试。通过Kappa方法研究可靠性，Kappa方法定义为校正了偶然一致性后的观察者间一致性。以总体Kappa衡量的观察者间一致性良好（K = 0.69±0.05），各部门、专业类别或病因之间无显著差异。关于RLS 85的各个水平，除了退缩反应（K = 0.51）和屈肌反应（K = 0.55）外，Kappa值均高于0.65。在昏迷方面观察者间一致性良好（K = 0.71）。总之，RLS 85被证明易于学习，它显示出全面覆盖且无伪评分情况，并且被两个斯堪的纳维亚国家四个不同神经外科部门的医生、护士和助理护士以一致的方式使用。
