The records of 187 patients (age 6 months to 82 years) who sustained severe closed head injuries and were admitted to a neurosurgical unit between 1983 and 1987 were retrospectively reviewed. The aim was to develop a scale for selecting patients whose death could be predicted with certainty at an early stage and who should therefore not receive prolonged intensive care. The scale was prospectively tested on 52 comparable patients admitted during 1988 and was found to be accurate with no falsely pessimistic predictions. The score is based mainly on clinical observations within 12 h of presentation.