Scales of gravity in head injury

From the head injury onward the victim loses control over his own existence and starts a long journey through the various fields of forces determining his destiny until he can reassume control. Scales of gravity applied at different points in time vary and sometimes contradict each other. The vital scale is an immediate emergency scale, determined by the need to save a life, observe and treat a coma, and detect early complications, and the criteria are those of intensive care, surgery, and neurosurgery. The neurological and neuropsychological scale established towards the end of the first hospitalisation, assesses brain damage by neurological investigations, ophthalmological and otological tests and a neuropsychological evaluation. First individual psychiatric reactions appear at this stage. The psychosocial scale should consider information provided by previous scales, but also evaluate pre- and post-traumatic personality, family setting, social, legal, administrative and economic realities, residual skills, previous profession, possibilities of reinstatement and above all, motivation. Probably the neurological and neuropsychological scale provide the best common point of reference for a global assessment. These scales of gravity are examined in their relationship to traditional clinical thinking in different countries. A prospective and descriptive system of a "European" cofification as proposed within the framework of the European Communities is described.