%0 Journal Article
%J Crit Care Med
%D 2012
%T Clinical examination for outcome prediction in nontraumatic coma
%A Greer, David M
%A Yang, Jingyun
%A Scripko, Patricia D
%A Sims, John R
%A Cash, Sydney
%A Kilbride, Ronan
%A Wu, Ona
%A Hafler, Jason P
%A Schoenfeld, David A
%A Furie, Karen L
%K Algorithms
%K Chi-Square Distribution
%K Coma
%K Emergency Service, Hospital
%K Female
%K Humans
%K Hypoxia
%K Hypoxia-Ischemia, Brain
%K Male
%K Middle Aged
%K Neurologic Examination
%K Outcome Assessment (Health Care)
%K Prospective Studies
%K Reflex, Pupillary
%K Statistics, Nonparametric
%K Subarachnoid Hemorrhage
%K Treatment Outcome
%X OBJECTIVES: Determine the utility of the neurologic examination in comatose patients from nontraumatic causes in the modern era. DESIGN: Prospective observational study. SETTING: Single academic medical center. PATIENTS: Data from 500 patients in nontraumatic coma collected sequentially from 2000 to 2007 in the emergency department and neuroscience, medical, and cardiac intensive care units. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical data were collected on days 0, 1, 3, and 7. Outcome was assessed at 6 months; good outcome was determined at two levels by modified Rankin Scale, ≤3 as independence and ≤4 as moderate but not severe disability. A classification and regression tree analysis was performed to determine prognostic variables, creating predictive algorithms of good vs. poor outcome for each day. Patients with coma attributable to subarachnoid hemorrhage (4/80; 5%) or global hypoxic-ischemic injury (20/202, 10%) were more likely to achieve good outcomes. The pupillary reflex was an important determinant, regardless of day or modified Rankin Scale cut point (mean odds ratio 12.51, range [6.01, 22.56] for modified Rankin Scale ≤3; mean odds ratio 19.26, range [5.38, 42.26] for modified Rankin Scale ≤4). A less robust effect was seen for oculocephalic reflexes (mean odds ratio 62.61, range [2.24, 177] for modified Rankin Scale ≤3; mean odds ratio 34.13, range [4.95, 89.93] for modified Rankin Scale ≤4). The motor response was selected as a predictor of outcome only on day 0 (odds ratio 2.35, 95% confidence interval 0.64-5.74 for modified Rankin Scale ≤3; odds ratio 2.1, 95% confidence interval 0.81-4.24 for modified Rankin Scale score ≤4). Age was not associated with outcome. CONCLUSIONS: The clinical neurologic examination remains central to determining prognosis in nontraumatic coma. Additional clinical and diagnostic variables may also aid in outcome prediction for specific disease states.
%B Crit Care Med
%V 40
%P 1150-6
%8 2012 Apr
%G eng
%N 4
%1 http://www.ncbi.nlm.nih.gov/pubmed/22020245?dopt=Abstract
%R 10.1097/CCM.0b013e318237bafb