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PubMed2004

Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years.

BACKGROUND: Age and the Glasgow Coma Scale (GCS) score on admission are considered important predictors of outcome after traumatic brain injury. We investigated the predictive value of the GCS in a large group of patients whose computerised multimodal bedside monitoring data had been collected over the previous 10 years. METHODS: Data from 358 subjects with head injury, collected between 1992 and 2001, were analysed retrospectively. Patients were grouped according to year of admission. Glasgow Outcome Scores (GOS) were determined at six months. Spearman's correlation coefficients between GCS and GOS scores were calculated for each year. RESULTS: On average 34 (SD: 7) patients were monitored every year. We found a significant correlation between the GCS and GOS for the first five years (overall 1992-1996: r = 0.41; p<0.00001; n = 183) and consistent lack of correlations from 1997 onwards (overall 1997-2001: r = 0.091; p = 0.226; n = 175). In contrast, correlations between age and GOS were in both time periods significant and similar (r = -0.24 v r = -0.24; p<0.002). CONCLUSIONS: The admission GCS lost its predictive value for outcome in this group of patients from 1997 onwards. The predictive value of the GCS should be carefully reconsidered when building prognostic models incorporating multimodality monitoring after head injury.

Adolescent↗
PubMed2004

[Physical diagnosis--the Glasgow coma scale for the measurement of disturbances of consciousness].

The Glasgow coma scale (GCS) may be used for the evaluation of disturbances of consciousness. The GCS is a reliable and reproducible test that can easily be carried out at the patient's bedside. The GCS can be used to assess the severity of a head injury and to determine the prognosis of the patient. The prerequisites for a reliable determination of the GCS-score are training of inexperienced personnel, re-assessment by a physician with experience in neurology, correction for external factors and reporting in accordance with a protocol.

Consciousness↗
PubMed1992

[Acoustic evoked brainstem potentials--patterns of stimulus artefacts in irreversible coma].

Brainstem auditory evoked potentials (BAEP) were performed in a total of 20 subjects (mean age 33.2 +/- 15.1 years; severe head injury in most cases) with the diagnosis of coma dépassé. The control group consisted of 33 healthy volunteers (mean age 26.9 +/- 5.3 years). The presence, latency and amplitude of the single BAEP-components and the variations of the stimulus artifact were evaluated. The mean amplitudes of the stimulus artifact of the brain dead subjects were calculated (means +/- SD) to be 0.26 +/- 0.12 microV (control group: 0.11 +/- 0.03 microV). Pathological alterations of the mechanics of the inner ear as well as extracerebral changes in conductivity or stimulus related depolarization processes in extracerebral parts of the auditory system were taken into consideration to be possible reasons for this significant (p less than 0.001; t-test) difference.

Adolescent↗
PubMed2004

Whole-brain apparent diffusion coefficient in traumatic brain injury: correlation with Glasgow Coma Scale score.

BACKGROUND AND PURPOSE: Patients with traumatic brain injury (TBI) and low Glasgow coma scale (GCS) scores may have severe injury associated with cellular disruption that can be studied with whole-brain apparent diffusion coefficient (ADC) histograms. We retrospectively studied this hypothesis and correlated ADC with GCS. METHODS: Twenty-one patients (37.81 +/- 41.3 years) with TBI were enrolled: Group A had normal MR imaging findings but low GCS scores (n = 6). Group B had brain stem injury with low GCS scores (n = 6). Group C had cortical lesions with normal GCS scores (n = 5), and group D had cortical lesions with low GCS scores (n = 4). Eleven control subjects were enrolled (32.7 +/- 19.2 years). Whole-brain ADC maps and histograms were generated and normalized for each subject. Mean and peak ADCs were determined. A one-sided t test was performed for each parameter. Average GCS scores and corresponding peak and mean ADCs were correlated. RESULTS: Peak histogram values significantly differed between controls and groups A, B, and D (P <.0019, P <.00129, and P <.0148, respectively). In groups A and D, values were significantly skewed compared with control values. Mean ADC was significantly different between the control ADC and group A (P <.013) but not group C. In each group, peak ADC and GCS score were strongly correlated (R(2) = 0.67). CONCLUSION: Whole-brain peak ADCs and GCS scores are significantly correlated in patients with TBI. Although conventional MR images were normal, ADC independently indicated TBI and better represents the degree of neurologic dysfunction.

Adolescent↗
PubMed2004

Solitary fibrous tumor of the liver with presenting symptoms of hypoglycemic coma.

We report a patient with solitary fibrous tumor of the liver, a rare fibrous neoplasm which to our knowledge has been reported in only 21 patients in the English literature. Most frequently, solitary fibrous tumors arise in the thoracic cavity, particularly in the pleura. Hypoglycemia has rarely been associated with these mesenchymal tumors. The presentation of this patient with hypoglycemic coma without preceding symptomatology, to our knowledge, has never been reported.

Aged↗
PubMedDate not supplied

[Optimization of the infusion therapy in patients with diabetic hyperglycemic ketoacidosis coma].

The clinical efficiency and comparative analysis of the infusion schemes are defined for patients with diabetic hyperglycemic ketoacidosis coma (DHKC) on the basis of integral scales of the severity status of patients as well as on the basis of an intensity of multiple organ failure. According to the study results, a choice of an infusion scheme made with due respect to a patient's severity condition ensures a timely support to the systemic hemodynamics, circulating blood volume, concentration of the main osmolar components and to the colloid-oncotic pressure. The infusion schemes, which are a basis for intensive care of the DHKC patients, balanced both qualitatively and quantitavely, contribute to the prevention of multiple organ failure and significantly cut the lethality rate.

Adolescent↗
PubMed1976

[Value of cerebral metabolic exploration in post-traumatic coma states in the acute phase].

The authors report the values of mean hemispheric blood-flow and cerebral arterial consumption they found in 34 neurosurgical comatous cases in acute state. In basal conditions, mean values of mean hemispheric bloodflow and oxygen consumption are lowered. There seems to be a relation between the values found and the comatous stage on one hand, the prognosis on the other hand. The cerebral response to hypercapnia (16 assays) allows to separate 2 groups, one with a noticeable improvement of cerebral bloodflow, the other with only a minimal response. There was no significant variation of cerebral oxygen consumption in both group. Cerebral response to CO2 seems to be clearly related to the stage of coma (low in the most severe cases) but pronostic incidence remained uncertain. A hypertensive test by means of Aramine (18 assays) allows to separate 3 groups : 1 group (8 cases) where the mean hemispheric bloodflow remained stable during hypertension as did the cerebral oxygen consumption -(autoregulation remained unchanged), 1 group (4 cases) where mean hemispheric bloodflow and cerebral oxygen consumption were lowered (excessive autoregulation), 1 group (6 cases) where mean hemispheric bloodflow increases clearly while under Aramine perfusion (loss of autoregulation). Those dynamic tests, either hypercapnic or hypertensive, allow, in comparing oxygen consumption variations with cerebral bloodflow variations, the distinction between : patients where metabolic autoregulation seems maintained (good prognosis) - (10 cases), patients where metabolic regulation is lost with either "luxury perfusion" (14 cases) - poor prognosis, or "insufficient perfusion" (10 cases). The authors are discussing the treatment concerning those last mentioned patients.

Brain↗
PubMedDate not supplied

Using a coma scale to assess patient consciousness levels.

The Glasgow coma scale is the most widely used method for assessing a patient's level of consciousness. This article outlines the Leeds Teaching Hospitals NHS Trust's guidelines to assist practitioners with the practical aspects of carrying out and interpreting the scale.

Consciousness Disorders↗
PubMed2005

[Clinical reasoning and decision making in practice: a 30-year-old man with unexplained coma].

A 30-year-old man known to have a factor-IX deficiency was presented at the emergency department with unexplained coma. After immediate treatment with factor IX, a CT-scan of the brain revealed no intracerebral haemorrhage. However, blood tests showed severe hyponatraemia, low serum osmolarity and high urine-sodium excretion consistent with the Syndrome of Inappropriate Antiduretic Hormone Secretion (SIADH). Therapy with hypertonic saline was instituted resulting in a gradual rise in the serum-sodium concentration. The cause of the hyponatraemia however remained unclear. After repeat history taking the patient mentioned the use of desmopressin for nocturia. Hyponatraemia as a complication of desmopressin use occurs in 8% of adult patients treated for nocturia. Direct availability of a patient's drug history, by means of an electronic record for instance, could avoid unnecessary tests and delay in diagnosis.

Adult↗
PubMed2005

Multifactorial hypoglycaemic coma in female bodybuilder.

A 31-year-old female bodybuilder who was admitted to the Clinic because of deep coma and hypoglycaemia was presented. For last six weeks she had been preparing for a competition doing aerobic and anaerobic exercises, ingesting rich-protein and low-carbohydrate diet and administering a low dose of somatotropin every day. Even for the regional competitions there is a need for exact doping check among young athletes. Growth hormone in a small dosage taken together with low-carbohydrate and rich-protein diet can provoke deep hypoglicemia among people who use it for doping purposes.

Adult↗
PubMed1992

[Coma during a hip prosthesis under spinal anesthesia. Apropos of a case].

A case is reported of a postoperative coma in a ASA I 79 years old patient undergoing a spinal anaesthesia for hip prosthesis. The complication occurred three hours after the subarachnoidal puncture and 90 minutes after the completion of surgery. A complete recovery was observed in the following 48 hrs with the help of symptomatic treatments. Possible aetiologies and mechanisms of such accidents are discussed. However no definite cause could be ascertained in the case reported above, which is to add to similar ones observed during spinal anaesthesia in healthy patients. Anyhow, close surveillance is always mandatory.

Aged↗
PubMed2005

Multiple imputation of the Glasgow Coma Score.

BACKGROUND: To investigate whether multiple imputation (MI) of missing Glasgow Coma Scale (GCS) values generates more accurate GCS frequency distributions and less biased parameter estimates in logistic regression models predicting mortality than the standard procedure of excluding observations with missing GCS values. METHODS: The study population consisted of 5,065 patients with complete GCS information from the trauma registry of a Level 1 trauma center. Missing GCS values were imposed on the data set, and the performance of MI (extrapolating missing GCS from a data prediction model) and of deleting all data observations with missing GCS (list-wise deletion) were evaluated. GCS and Trauma and Injury Severity Score (TRISS) frequency distributions and parameter estimates were compared with true values from the original data set. RESULTS: GCS and TRISS frequency values generated by MI were much more accurate than those generated by list-wise deletion. GCS and TRISS parameter estimates generated by MI all had acceptable bias and coverage rates when compared with true values. List-wise deletion provided biased parameter estimates for the GCS, the Revised Trauma Score, and the Injury Severity Score. CONCLUSION: MI is a valid solution to the problem of missing GCS data in trauma research. It allows the conservation of precious data observations and leads to unbiased estimates in consequent analyses. Analyses, which exclude observations with missing GCS data, provide biased results.

Biomedical Research↗
PubMed1992

[Folk healing causing severe diabetic coma].

The authors demonstrate on the case of a 21-year-old female diabetic (type I), who had been well compensated with insulin for five years, the life threatening procedure of a popular healer. By eliminating insulin he induced severe keto acidotic coma.

Adult↗
PubMedDate not supplied

[Clinical and computed tomographic comparisons of analysis of the condition in children with brain injury of 13-15 scores by the Glasgow Coma Scale on admission to hospital].

Clinical and computed tomographic comparisons were made in 590 children with mild brain injury (BI). The children admitted for BI of 13-15 scores assessed by the Glasgow coma scale (GCS) in the first hour after injury were examined. They all underwent brain computed tomography (CT), skull X-ray study, and neurological studies. Their history data were analyzed. 73% of the children were admitted within the first 12 hours following injury. Falling from the growth height was mainly responsible for BI (45.2%). The frequency of the CT signs of BI was 36.3%. Surgical treatment was required in 5.8% of the children; among them 4.4% and 1.4% were operated on for depressed fractures and intracranial hematomas, respectively. A relationship was found between the presence of the CT signs of BI and the GCS scores on admission. With 15 and 13 GCS scores, the positive CT pattern was detected in 16 and 70% of cases. Well-defined focal neurological symptoms and multiple vomiting (38 and 57%, respectively) are predictors of acute pathology on a CT scan. X-ray skull fracture increases the likelihood of CT pathology up to 62%. Consciousness disturbance of as high as 13-14 GCS score concurrent with noticeable neurological symptoms and skull fracture increases the probability of the positive CT pattern up to 93%. X-ray and CT studies did not reveal acute traumatic injuries when there were traces of skull injury in the presence of clear consciousness and in the absence of vomiting.

Adolescent↗
PubMed1991

Multiple bullae and paresis after drug-induced coma.

Two cases of bullous skin lesions and paresis following coma due to the ingestion of many antipsychotic drugs were reported. Histological examination showed an intra-epidermal blister in case 1 and degeneration of sweat glands in both cases. An immunofluorescence study showed massive deposits of IgM and C3 in the dermal vessels. As similar deposits of immunoglobulin and complement were not observed in patients with ordinary lesions such as decubitus, a different mechanism in the formation of the bullous skin lesion other than pressure is suggested.

Adult↗
PubMed1991

[Prolonged traumatic coma caused by diffuse axonal lesions].

A 22-year old male patient was admitted for deep coma probably of traumatic origin. There was neither fracture of the skull nor expansive intracranial lesion. The patient survived for 6 years and 8 months without any change in consciousness. Post-mortem neuropathological examination showed lesions which predominated in the white matter and had features that were compatible with diffuse axonal injury. The mechanism responsible for these lesions seems to be stretching and shearing of axones at the moment of impact. The exceptionally long duration of survival probably accounts for the severity of the lesions observed.

Adult↗
PubMed1991

Myxedema coma.

Myxedema coma is a rare condition associated with high mortality. The pathophysiology is complex and often involves profound hypothyroidism as well as an inciting event. The diagnosis should be suspected based on the clinical presentation, and treatment should not be delayed while awaiting confirmatory laboratory data. In critically ill patients, laboratory differentiation between severe hypothyroidism and the euthyroid-sick syndromes is difficult and may require measurement of free hormone levels. Treatment consists of correction of electrolyte abnormalities, passive rewarming, treatment of infections, respiratory and hemodynamic support, administration of stress-dose glucocorticoids, and thyroid hormone replacement. Intravenous thyroxine, between 200 and 500 micrograms as the initial dose followed by 50 to 100 micrograms/day, is recommended. Concurrent therapy with triiodothyronine can also be considered.

Coma↗