Spread of Clostridium difficile among patients receiving non-absorbable antibiotics for gut decontamination.

Abstract

Adoption of Glasgow Coma Scale in the British Isles One million head-injured patients attend British hospitals each year.Deciding who to admit and who to refer for specialised management depends on a reliable means of estimating conscious level-that is, an index of both the initial severity of injury and, if this changes, the development of intracranial complications.The Glasgow Coma Scale is a reliable and practical method of assessing conscious level in terms of three independently measured features-namely, eye opening, motor response, and verbal response.'It has been widely recommended2 and adopted in many parts of the world as a guide to the management of patients with various forms of acute brain damage.Little informa- tion exists, however, on how widely the scale has been adopted by the two different kinds of unit-primary surgical units and neurosurgical units-that care for head injuries in Britain or about the factors that led to its adoption. Methods and resultsWe sought information from all 31 Scottish hospitals that treat at least 10 head-injured patients a week and admit patients to their own wards for observation3 and requested similar data from the 42 neuirosurgical units in the British Isles other than our own.We asked each unit about the method used to assess conscious level, its origin, and the reasons for its adoption and requested a specimen of the head-injury observation chart in local use.Methods used to assess head-injured patients in neurosurgical units in British Isles and Scottish primary surgical hospitals Glasgow Other Entries Coma graded in case Scale systems notes Neurosurgical units .219 10 Scottish hospitals* served by neurosurgeons who use: Glasgow Coma Scale.. 21 2 Another method 6 2*Two regional neurosurgical units used Glasgow Coma Scale and two another method.Two-thirds of British neurosurgical units with a formal grading system used the Glasgow Coma Scale (table); no two of the nine other units used the same system.Of the six primary Scottish hospitals that used an alternative system, only two used the same one.Only where the regional neurosurgeons used the Glasgow system did the primary hospitals do so.