The presence of certain risk factors in comatose patients shortly after the onset of coma is associated with poor outcome (severe disability or mortality) within 2 months.
Etiologies of coma in study population: cardiac arrest, cerebral infarction or intracerebral hemorrhage, hypoglycemia
Excluded: trauma, drug intoxication, thyrotoxicosis or myxedema, operative complication, hypothermia, diabetic ketotic coma, nonketotic hyperosmolar coma, hepatic encephalopathy, secondary to uremia, secondary to hyper- or hypo-calcemia, secondary to hyper- or hyponatremia.
The patient evaluation is performed on day 3 after onset of coma.
Independent Risk Factor |
Odds Ratio |
95% CI |
abnormal brain stem response |
3.2 |
1.3 - 8.1 |
absent verbal response |
4.6 |
1.8 - 11.7 |
absent withdrawal to pain |
4.3 |
1.7 - 10.8 |
creatinine >= 132.6 µmol/L (1.5 mg/dL) |
4.5 |
1.8 - 11.0 |
age >= 70 years |
5.1 |
2.2 - 12.2 |
where:
• Abnormal brain stem function is indicated if one or more of the following are present: (1) absent pupillary response, (2) absent corneal response, (3) absent or dysconjugate roving eye movements
• Neurologic signs incompatible with abnormal brain stem function: (1) verbal response with inappropriate words or better, (2) motor response of obeying verbal commands or localizing to pain, (3) eye opening spontaneously or to verbal command
prognostic score =
= SUM(risk factors present)
Interpretation:
• minimum number of risk factors = 0
• maximum number of risk factors = 5
• The more the number of risk factors, the greater the chances for a poor outcome.
• The presence of either an abnormal brain stem response or absent motor response to pain is associated with a 96% chance of severe disability or death at 2 months.
Number of Risk Factors Present |
Mortality at 2 Months |
0 |
26% |
1 |
47% |
2 |
60% |
3 |
90% |
4 |
96% |
5 |
100% |
from Table 4, page 1846, total sample data
Purpose: To identify comatose patients at risk for death or severe disability within a few days of onset.
Specialty: Sports Medicine & Rehabilitation, Neurology
Objective: risk factors, severity, prognosis, stage
ICD-10: R40.2,