For healthcare professionals
Richmond Agitation-Sedation Scale (RASS)
The Richmond Agitation-Sedation Scale rates agitation and sedation on 10 levels, from +4 (combative) to -5 (unarousable), with 0 for alert and calm. Sessler and colleagues published it in 2002 for adult intensive care patients. This tool is written for clinicians and is not a diagnosis.
Level
Choose the level that best describes the patient. Levels -1 to -3 depend on the response to voice, and -4 and -5 on the response to physical stimulation. Nothing you enter leaves this page.
What you will see
The RASS level, its term and description, and the range it falls in.
Educational only, not medical advice. Not a diagnosis. Sedation decisions belong to the treating team.
Source
Sessler CN and colleagues, American Journal of Respiratory and Critical Care Medicine 2002. The levels, terms and descriptions are taken from Table 1 of an open-access (CC BY) study, Kumar N and colleagues, Turkish Journal of Anaesthesiology and Reanimation 2026, which also describes the ranges. The tests check all 10 levels, the terms and the ranges.
Validated in
Adult intensive care patients: medical, surgical, cardiac surgery, coronary and neuroscience units, with and without mechanical ventilation and sedative medicines (Sessler 2002). It has also been studied in older emergency department patients (Coskun Yas 2026).
Limits
The scale is subjective and depends on the user's interpretation, and it is not continuous (Kumar 2026). In a study of older emergency department patients cited by Coskun Yas 2026, agreement between trained research staff and an emergency physician was moderate (kappa 0.63).
RASS levels
| Score | Term | Description |
|---|---|---|
| +4 | Combative | Overtly combative or violent; immediate danger to staff |
| +3 | Very agitated | Pulls on or removes tube(s) or catheter(s) or has aggressive behavior toward staff |
| +2 | Agitated | Frequent non-purposeful movement or patient-ventilator dyssynchrony |
| +1 | Restless | Anxious or apprehensive but movements not aggressive or vigorous |
| 0 | Alert and calm | Spontaneously pays attention to caregiver |
| -1 | Drowsy | Not fully alert, but has sustained (more than 10 seconds) awakening, with eye contact, to voice |
| -2 | Light sedation | Briefly (less than 10 seconds) awakens with eye contact to voice |
| -3 | Moderate sedation | Any movement (but no eye contact) to voice |
| -4 | Deep sedation | No response to voice, but any movement to physical stimulation |
| -5 | Unarousable | No response to voice or physical stimulation |
Levels as printed by Kumar and colleagues (Kumar 2026), from the scale published by Sessler and colleagues (Sessler 2002).
A score from -3 to 0 indicates light to moderate sedation, -4 and -5 indicate oversedation, and a score above 0 indicates insufficient sedation (Kumar 2026).
Worked example: a ventilated patient who awakens with eye contact to voice for less than 10 seconds is RASS -2, light sedation.
What the studies found
In the original study, agreement between five assessors in 192 adult intensive care encounters was excellent (r = 0.956, kappa 0.73), and the scale correlated closely with a visual analog scale of agitation and sedation (r = 0.93). After it was introduced in a medical intensive care unit, agreement between a nurse educator and 27 trained bedside nurses was high (kappa 0.80) (Sessler 2002).
In 10,208 emergency department patients aged 65 or older, in-hospital mortality rose from 2.2% at RASS 0 to 59.4% at -5 and 45.5% at +3. RASS and the Glasgow Coma Scale predicted mortality about equally well (area under the curve 0.683 and 0.679), and better together (0.712) (Coskun Yas 2026).
Related calculators
To score level of consciousness, see the Glasgow Coma Scale calculator. For alcohol withdrawal, see the CIWA-Ar calculator. Other bedside scores are listed under For healthcare professionals.
To screen for delirium, see the 4AT delirium test. In the ICU, the CAM-ICU delirium algorithm uses the RASS as its first step.
Sources
- Kumar N, Tiwari K, Pandey M. Relationship Between Patient State Index and Richmond Agitation Sedation Scale for Sedation in Critically Ill Patients: An Observational Study. Turk J Anaesthesiol Reanim. 2026;54(3):200-208. doi:10.4274/tjar.2026.262486. PMID 42360077. Open access (CC BY). Table 1 (RASS levels, terms and descriptions), Introduction and Discussion (ranges, limits). pmc.ncbi.nlm.nih.gov/articles/PMC13308569/
- Coskun Yas S, Aslaner MA. Prognostic Value of the Richmond Agitation-Sedation Scale for Mortality and Admission in Older Emergency Department Patients. Medicina (Kaunas). 2026;62(9):1803. doi:10.3390/medicina62091803. PMID 42796409. Open access (CC BY). Introduction (interobserver agreement) and Results (10,208 patients, mortality by RASS level, AUC). pmc.ncbi.nlm.nih.gov/articles/PMC13608948/
- Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338-1344. doi:10.1164/rccm.2107138. PMID 12421743. Abstract (inter-rater reliability and validity). pubmed.ncbi.nlm.nih.gov/12421743/
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-02. Spotted an error? See About.