Nontraumatic coma. Glasgow coma score and coma etiology as predictors of 2-week outcome
R. L. Sacco, R. VanGool, J. P. Mohr and W. A. Hauser
Neurological Institute, New York, NY 10032.
In 1987 and 1988, we carried out a prospective study of patients older than
10 years with nontraumatic coma in the intensive care units of
Columbia-Presbyterian Medical Center, New York, NY. Of 188 patients with
Glasgow Coma Scale (GCS) determinations within 72 hours, 61% were dead or
in persistent coma by 2 weeks from onset. Age, sex, and ethnicity did not
influence outcome. The 2-week outcome for patients with initial GCS of 3 to
5 was 14.8% awake; 85.2% were dead or in persistent coma. For the GCS 6 to
8 group, 53.1% were awake and 46.9% were dead or in persistent coma.
Hypoxic or ischemic coma had the worst 2-week outcome (79% dead or
comatose); coma caused by metabolic disease or sepsis (68%), focal cerebral
lesions (66%), and general cerebral diseases (55%) were intermediate, while
drug-induced coma had a favorable outcome (27% dead or comatose). The
independent predictors of 2-week outcome were the first GCS and
drug-induced coma. The predicted probability of waking at 2 weeks was eight
times better for drug-induced coma than other causes when GCS was held
constant. Patients with an initial GCS score of 6 to 8 were seven times
more likely to waken than those with a score of 3 to 5. The motor subscore
alone was a significant independent predictor of 2-week outcome.
Modification of coma score to include etiology may give more accurate
predictions of 2-week outcome after nontraumatic coma.
