A neurosurgical audit scale has been devised to provide a measure of disability and outcome. The audit scale was tested for observer variation and sensitivity against the Karnofsky scale, the Rosser disability scale and the Rosser distress scale. The highest ratio of observer concurrence compared with chance was noted for the neurosurgical audit scale, and the lowest ratio for the Rosser distress score. Sensitivity was almost identical for each of the scales. The neurosurgical audit scale lends itself to audit based on a computer database for which the input is the discharge summary. This achieves audit without additional work for either medical or secretarial staff.