Can one Predict Outcome of Medical Coma?

Abstract

The combined evaluation of the motor response to stimulation and the oculovestibular (OV) reflex gives useful indicants to the outcome of medical coma. We examined 48 patients during the first 12 h and at 24 h after the onset of medical coma. We excluded patients who had ingested drugs or who had hypothermia. Motor responses to a noxious stimulus were scored on a 6 ‘best’ and 1 ‘worst’ scale, and the presence or absence of oculovestibular responses to icewater irrigations was recorded. Subjects were divided by outcome at three months into three groups: death or persistent vegetative state, severe disability, and moderate disability or good recovery. On the basis of the present series it was often possible to distinguish among the outcomes at or before 24 h. The patient's age and the presence or absence of pupillary responses, spontaneous eye movements and oculocephalic responses were not predictive of outcome, nor were the respiratory pattern, blood gases, blood pressure, heart rate and temperature. A minimal motor score and an absence of oculovestibular responses at 12 h always were associated with death. With higher motor scores, the absence of oculovestibular responses at either 12 or 24 h implied an outcome no better than severe disability. The results of the present study imply that early bedside assessments can yield accurate predictive information in medical coma.