Johnstone A J, Lohlun J C, Miller J D, McIntosh C A, Gregori A, Brown R, Jones P A, Anderson S I, Tocher J L
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
Brain Inj. 1993 Nov-Dec;7(6):501-6. doi: 10.3109/02699059309008177.
The Glasgow Coma Scale (GCS) and the Swedish Reaction Level Scale (RLS85), two level-of-consciousness scales used in the assessment of patients with head injury, were compared in a prospective study of 239 patients admitted to a regional head injury unit over a 4-month period. Assessments were made by nine staff members ranging from house officer to registrar, after briefing about the two scales. Data were also collected on age, nature of injuries, surgical treatment, and condition at discharge or transfer using the Glasgow Outcome Scale. Both the GCS and the RLS85 reliably identified comatose patients and those with minor head injury, but were much less effective in defining the response level in patients considered to have a moderate head injury. Only 41% of the patients allocated to a moderate-head-injury category by the GCS and the RLS85 were common to both groups. Where a mismatch occurred, neither scale allocated patients to a 'better' or 'worse' category more frequently than the other. Assessment of patients' conscious levels using the GCS was difficult in only two cases. One patient had facial injuries, and the other was intubated. The RLS85 was reported by all users to be simpler to use than the GCS, but the latter is much more widespread in use. Both scales function well in cases of severe and minor head injury, but have weaknesses when defining moderate head injury. Level-of-consciousness scales are only an aid to assessment and the final choice between the two scales must remain a matter of personal or departmental preference.
在一项对一家地区性颅脑损伤病房4个月内收治的239例患者的前瞻性研究中，对格拉斯哥昏迷量表（GCS）和瑞典反应水平量表（RLS85）这两种用于评估颅脑损伤患者意识水平的量表进行了比较。在对这两种量表进行简要介绍后，由9名从住院医师到住院总医师的工作人员进行评估。还收集了患者的年龄、损伤性质、手术治疗情况以及使用格拉斯哥预后量表评估的出院或转院时的状况等数据。GCS和RLS85都能可靠地识别昏迷患者和轻度颅脑损伤患者，但在确定被认为是中度颅脑损伤患者的反应水平方面效果要差得多。根据GCS和RLS85被归类为中度颅脑损伤的患者中，只有41%在两组中是相同的。当出现不一致的情况时，两种量表将患者分配到“较好”或“较差”类别中的频率没有明显差异。使用GCS评估患者意识水平时，仅在两例患者中遇到困难。一例患者面部受伤，另一例患者进行了气管插管。所有使用者都报告说RLS85比GCS更易于使用，但GCS的使用更为广泛。两种量表在重度和轻度颅脑损伤病例中都能很好地发挥作用，但在定义中度颅脑损伤时存在不足。意识水平量表只是评估的辅助工具，最终在两种量表之间的选择仍取决于个人或科室的偏好。
