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Richmond Agitation–Sedation Scale (RASS)

Classifies critically ill patients’ agitation or sedation, from combative (+4) to unarousable (−5), and guides sedation adjustment and delirium assessment.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

RASS/Sessler 2002; Ely 2003: −5 to +4, observation→voice→physical stimulus

The 2002 RASS was studied for agitation and sedation in adult ICU patients, with and without ventilation or sedatives, and involved trained raters. The result depends on appropriate observation and application; alone, it is neither a delirium diagnosis nor a sedative-dose prescription. Pediatric use and treatment protocols require their own sources.

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Observed level required

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Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Observed level

6/6 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Assessment in 3 steps: (1) observe for 30 s (0 to +4); (2) if not alert, call the patient’s name and ask them to look at you (−1 to −3); (3) if there is no voice response, physically stimulate by shaking the shoulder or rubbing the sternum (−4 to −5).

References

Identifier: rass

Original clinical content: Brazilian Portuguese.

Method version

RASS/Sessler 2002; Ely 2003: −5 to +4, observation→voice→physical stimulus

rass@native-2026-10-03+1760c42d707f

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (6)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Observed level: −4 · Deep sedation: no response to voice; movement with physical stimulation

{
  "rass": "-4"
}

Expected result

{
  "score": -4,
  "level": "high"
}

Actual result

{
  "score": -4
}

Case 2

reference-002

Inputs

Observed level: −3 · Moderate sedation: movement or eye opening to voice, no eye contact

{
  "rass": "-3"
}

Expected result

{
  "score": -3,
  "level": "mid"
}

Actual result

{
  "score": -3
}

Case 3

reference-003

Inputs

Observed level: −2 · Light sedation: awakens to voice, eye contact for less than 10 s

{
  "rass": "-2"
}

Expected result

{
  "score": -2,
  "level": "low"
}

Actual result

{
  "score": -2
}

Case 4

reference-004

Inputs

Observed level: 0 · Alert and calm

{
  "rass": "0"
}

Expected result

{
  "score": 0,
  "level": "low"
}

Actual result

{
  "score": 0
}

Case 5

reference-005

Inputs

Observed level: +1 · Restless: anxious, non-aggressive movements

{
  "rass": "1"
}

Expected result

{
  "score": 1,
  "level": "mid"
}

Actual result

{
  "score": 1
}

Case 6

reference-006

Inputs

Observed level: +3 · Very agitated: pulls or removes tubes and catheters; aggressive

{
  "rass": "3"
}

Expected result

{
  "score": 3,
  "level": "high"
}

Actual result

{
  "score": 3
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.