Risk Factors of Hamel for Death or Severe Disability in Comatose Patients

 

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