A COMPARISON OF THE GLASGOW-COMA-SCALE AND THE SWEDISH-REACTION-LEVEL-SCALE

The Glasgow Coma Scale (GCS) and the Swedish Reaction Level Scale (RLS 85), two level-of-consciousness scales used in the assessment of patie nts with head injury, were compared in a prospective study of 239 pati ents admitted to a regional head injury unit over a 4-month period. As sessments were made by nine staff members ranging from house officer t o registrar, after briefing about the two scales. Data were also colle cted on age, nature of injuries, surgical treatment, and condition at discharge or transfer using the Glasgow Outcome Scale. Both the GCS an d the RLS85 reliably identified comatose patients and those with minor head injury, but were much less effective in defining the response le vel 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, n either scale allocated patients to a 'better' or 'worse' category more frequently than the other. Assessment of patients' conscious levels u sing the GCS was difficult in only two cases. One patient had facial i njuries, and the other was intubated. The RLS85 was reported by all us ers to be simpler to use than the GCS, but the latter is much more wid espread 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 fi nal choice between the two scales must remain a matter of personal or departmental preference.