Substance misuse in psychiatric inpatients: comparison of a screening questionnaire survey with case notes.

and did not result in a clarifying change of name. No evidence has been published that the continued use of the 14 point scale may have caused harm to any patient. The practice does, however, lead to difficulties. Staff from one hospital told us about their recurrent problems communicating with the local neurosurgical unit because the two were using different scales. In another trust, the neurological observation charts were changed after a recent coroner’s inquest: relatives of a patient who had died of severe traumatic brain injury had raised questions about the logic of two different versions of the Glasgow coma scale being used within the same trust. Users of the Glasgow coma scale need training to ensure consistency and reliability of scoring. The continued employment of two different scales can only add to the confusion. Although the 15 point Glasgow coma scale is not perfect, it should be used by everybody who manages patients with traumatic brain injuries until even better measures of consciousness are devised.