RASS Score Calculator (Richmond Agitation-Sedation Scale)
Look up the adult ICU RASS score chart or complete the original observation-to-stimulation assessment sequence.
Content updated: View sources
QuickMedCalc is developed and maintained by an independent developer. Medical content is not independently reviewed by a physician.
Formula and medical content are based on the references listed on this page. See sources, About, and Sources and Review Process.
Look up the original ten levels here, or use the structured assessment below.
| Score | Term | Published description |
|---|---|---|
| +4 | Combative | Overtly combative or violent; immediate danger to staff. |
| +3 | Very agitated | Pulls or removes tubes or catheters; aggressive. |
| +2 | Agitated | Frequent non-purposeful movement or patient–ventilator dyssynchrony. |
| +1 | Restless | Anxious or apprehensive; movements are not aggressive or vigorous. |
| 0 | Alert and calm | Alert and calm. |
| −1 | Drowsy | Sustained eye contact to voice for more than 10 seconds. |
| −2 | Light sedation | Brief eye contact to voice for less than 10 seconds. |
| −3 | Moderate sedation | Movement or eye opening to voice without eye contact. |
| −4 | Deep sedation | No response to voice; movement or eye opening to physical stimulation. |
| −5 | Unarousable | No response to voice or physical stimulation. |
- Score
- +4
- Term
- Combative
- Published description
- Overtly combative or violent; immediate danger to staff.
- Score
- +3
- Term
- Very agitated
- Published description
- Pulls or removes tubes or catheters; aggressive.
- Score
- +2
- Term
- Agitated
- Published description
- Frequent non-purposeful movement or patient–ventilator dyssynchrony.
- Score
- +1
- Term
- Restless
- Published description
- Anxious or apprehensive; movements are not aggressive or vigorous.
- Score
- 0
- Term
- Alert and calm
- Published description
- Alert and calm.
- Score
- −1
- Term
- Drowsy
- Published description
- Sustained eye contact to voice for more than 10 seconds.
- Score
- −2
- Term
- Light sedation
- Published description
- Brief eye contact to voice for less than 10 seconds.
- Score
- −3
- Term
- Moderate sedation
- Published description
- Movement or eye opening to voice without eye contact.
- Score
- −4
- Term
- Deep sedation
- Published description
- No response to voice; movement or eye opening to physical stimulation.
- Score
- −5
- Term
- Unarousable
- Published description
- No response to voice or physical stimulation.
About
This RASS score calculator supports two adult ICU tasks: look up any level from +4 through −5 in the score chart, or record the observed response sequence to identify its matching score and descriptor. Assessment proceeds from observation to voice and then, only when there is no response to voice, physical stimulation. [1, 2, 3]
The form records the observations that justify a descriptor rather than asking a user to choose +4 through −5. A not-assessable path withholds calculation when the sequence cannot be completed reliably; it is a software safety state, not another RASS level. [1]
Interpretation
+1 to +4: agitation descriptors of increasing intensity.
0: alert and calm.
−1 to −5: progressively reduced arousal or sedation descriptors.
Not assessable: no score. It is a QuickMedCalc safety state, not an eleventh RASS level and not −5.
RASS is an observed-state descriptor, not a mortality score, delirium diagnosis, pain score, universal sedation target, or medication order. [1, 2]
How to assess and interpret a RASS score
Why the page uses an assessment sequence
RASS is an observed descriptor, not a number-selection exercise. The original adult validation uses a fixed sequence: record spontaneous agitation or alertness first, assess response to voice when the person is not alert, and use physical stimulation only when there is no response to voice. The sequence preserves the observation that supports the final descriptor. [1, 2, 3]
Is there one “good” or target RASS score?
There is no universal “good” RASS score. A target is specific to the person, indication, and protocol. Current adult ICU guidance generally favors light rather than deep sedation when clinically appropriate, but this calculator reports the observed state and does not choose a target, medicine, or dose. [4, 6]
RASS is separate from CAM-ICU and the Ramsay Sedation Scale
RASS describes arousal, agitation, and sedation. CAM-ICU is a separate delirium assessment that may follow arousal assessment in ICU workflows; a RASS score is not a delirium diagnosis. The Ramsay Sedation Scale is also a distinct instrument with a different scoring system, so its scores are not interchangeable with RASS levels. [1, 2]
Not-assessable is a safety state, not an RASS level
The original adult RASS scale has ten levels from +4 through −5. QuickMedCalc uses not-assessable to withhold a score when the required response cannot be assessed reliably; it is not an eleventh level, and it is not silently converted to −5. [1]
Ventilation and specific assessment barriers
Mechanical ventilation or an endotracheal tube alone does not make a RASS assessment unassessable; the original adult validation included ventilated and non-ventilated ICU patients. Assessment may instead be limited by a specific barrier such as neuromuscular blockade, severe neurologic dysfunction, inability to observe the required response, communication barriers, or another condition that prevents a reliable sequence. [1, 2]
Adult implementation and pediatric validation
This implementation is limited to adult critical-care assessments. RASS itself has also been studied and validated in critically ill children, but this page does not provide pediatric interpretation or replace local pediatric assessment protocols. [1, 8]
Static PADIS context — not calculated
The 2018 PADIS guideline suggests light rather than deep sedation for appropriate mechanically ventilated adults. RASS does not set a universal target; the target depends on the person, treatment purpose, and applicable protocol. [4, 6]
The 2025 focused update conditionally suggests dexmedetomidine over propofol when light sedation and/or reducing delirium is the highest priority. This is static guideline context only: this page does not choose a medicine, dose, or target score. [5, 7]
References
- Sessler CN, 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. PMID 12421743. DOI 10.1164/rccm.2107138.
- Ely EW, et al. Monitoring sedation status over time in ICU patients. JAMA. 2003;289(22):2983–2991. PMID 12799407. DOI 10.1001/jama.289.22.2983.
- Virginia Commonwealth University. Richmond Agitation-Sedation Scale (RASS): ten-level scale and three-step assessment procedure. Accessed September 5, 2026.
- Devlin JW, et al. PADIS guideline. Crit Care Med. 2018;46(9):e825–e873. PMID 30113379. DOI 10.1097/CCM.0000000000003299.
- Lewis K, et al. Focused PADIS update. Crit Care Med. 2025;53(3):e711–e727. PMID 39982143. DOI 10.1097/CCM.0000000000006574.
- SCCM. Adult ICU PADIS guidance.
- SCCM. Focused PADIS update.
- Kerson AG, DeMaria R, Mauer E, et al. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. Journal of Intensive Care. 2016;4:65. PMID 27800163. PMCID PMC5080705. DOI 10.1186/s40560-016-0189-5.
FAQ
The page returns a not-calculable assessment. QuickMedCalc treats not-assessable as a safety state, not as an eleventh RASS level; it does not map uncertainty to −5 or display a partial score.
Sources: [1]
There is no universal good RASS score. A target is patient-, indication-, and protocol-specific. Current adult ICU guidance generally favors light rather than deep sedation when clinically appropriate, but this calculator reports the observed state and does not choose a target, medicine, or dose.
This implementation is limited to adult critical-care assessments. RASS itself has pediatric validation, but this page does not provide pediatric interpretation or replace local pediatric protocols.
Sources: [8]
Both describe sedation, but RASS includes explicit agitation levels and a defined observation-to-stimulation sequence. They are not interchangeable labels.
Sources: [1]
Mechanical ventilation or an endotracheal tube alone does not automatically make RASS unassessable; the original adult validation included ventilated patients. Specific barriers such as neuromuscular blockade, severe neurologic dysfunction, inability to observe the required response, communication barriers, or stimulation conditions can limit a reliable assessment.
Related Calculators
GCS
Record standard Glasgow Coma Scale eye, verbal, and motor responses, calculate a complete score when all are testable, and preserve Not Testable components without a fabricated total.
SOFA Score
Calculate the original Classic SOFA-1 score from raw clinical values across six organ systems in one defined 24-hour window, with an optional comparable-baseline change.
qSOFA
Calculate the original adult Sepsis-3 qSOFA prognostic prompt from respiratory rate, altered mentation, and systolic blood pressure.
Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.