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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 a 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. |
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