Prognosis in presumptive hypoxic-ischemic coma in nonneurologic trauma.
BACKGROUND
The neurologic outcome of comatose patients has a wide variation from complete reawakening to death. Methods of predicting the outcome of coma caused by either head injury or cardiac arrest have been the subject of much discussion in the literature. However, prediction of neurologic prognosis in comatose trauma patients without head injury has rarely been discussed. We reviewed our experience in treating patients with presumptive hypoxic-ischemic coma after trauma and tried to identify factors relating to their neurologic outcomes.


METHODS
Thirty-six patients with normal brain computed tomographic scans, who remained comatose 10 minutes after stabilization of their hemodynamic status, were studied. Serial motor response, verbal response, pupillary light reflex, presence of spontaneous breathing and seizure, and blood glucose level were recorded to evaluate their roles in predicting neurologic outcomes.


RESULTS
There were five deaths (mortality rate, 14%) and 11 patients (31%) with neurologic deficits. An absence of spontaneous breathing, a blood glucose level greater than 300 mg/dL during resuscitation, and a presence of seizure signified a poor prognosis. Initial neurologic evaluation at 10 minutes after stabilization of hemodynamic status was not accurate in predicting outcome. A motor response worse than withdrawal from painful stimuli at 24 hours after injury and an absence of pupillary light reflex at 48 hours after injury predicted a poor neurologic outcome, with a 100% accuracy rate.


CONCLUSIONS
Hypoxic-ischemic coma in patients sustaining major trauma yielded a significantly better survival and neurologic outcome than that induced by cardiac arrest or head injury. Decision-making in the first 24 hours after injury should not be affected by the patient's neurologic status at that time. A motor response worse than withdrawal at 24 hours after injury and an absence of pupillary light reflex at 48 hours after injury predicted a poor neurologic outcome.
Fang
J F
JF
Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan, Republic of China.
Chen
R J
RJ
Lin
B C
BC
Hsu
Y B
YB
Kao
J L
JL
Kao
Y C
YC
Chen
M F
MF
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003128:Coma / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D009460:Neurologic Examination / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012119:Respiration; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
D001786:Blood Glucose