Bromage, or not Bromage?

We were interested to read Hoyle and Yentis's paper on trends in the assessment of neuraxial blockade 1, particularly in regard to the number of different motor blockade scores ascribed to Bromage. The authors report that 97/102 (95%) reviewed papers described significant departures from the four-point score in Bromage's original paper 2 and book 3, but still credited them to Bromage. Whilst considering correction of our local guidelines we noted that, alongside our own, even significant publications including NAP3 4, referenced by the Royal College of Anaesthetists’ best practice statement on epidural monitoring 5, are not immune from this inaccuracy. Motor block assessment is fundamental to monitoring of neuraxial anaesthesia and clinical identification of serious complications. Unrecognised variation in scoring methods make objective comparison impossible and increase the chance for miscommunication and patient harm. It is notable that Hoyle and Yentis's paper shows that one of the variant scoring systems is used in 66/102 (65%) papers. Perhaps now is the time to decide, nationally, which scoring system we would like to use, and if it is not Bromage's, what to call it? It should also serve as a reminder that we must always check our sources.