Interobserver agreement in assessment of ocular signs in coma.

Berge, J; Schouten, H J; Boomstra, S; Littel, S van Drunen; Braakman, R.

doi:10.1136/jnnp.42.12.1163

Cited by 72 publications

(12 citation statements)

References 26 publications

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“…The pupillary light reflex and size equality of pupils had been shown to have a high interobserver reliability. [17] Therefore, the use of pupillary size and light reflex are indirect measures of dysfunction to pathways subserving consciousness and; thus, important clinical parameters in assessing outcome from traumatic coma. However, effort should be made to exclude direct occulomotor neuropathy before pupillary reactivity or size is considered a prognostic indicator.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria

Owolabi¹,

Mohammed²,

Dalhat³

et al. 2013

Indian Journal of Critical Care Medicine

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Background:Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution.Materials and Methods:In this prospective observational study, adults with clinically confirmed coma Glasgow coma scale (GCS) score of ≤8, admitted consecutively to the emergency unit of a tertiary hospital in Northwestern Nigeria over a period of 18 months were recruited. Vital parameters, severity of coma by GCS and neurological signs were recorded. The etiology of coma was determined on the basis of history, clinical examination, and laboratory investigations. Outcome was determined within 1 month of onset of coma by patients’ death or survival.Results:A total of 194 patients (140 males and 54 females) were recruited with mean age was 53.7 ± 1.4. The predominant etiological factors were central nervous system (CNS) infections (28.9%), toxic and metabolic (28.9%), and stroke (23.7%). Overall, 1-month mortality was 49%. On univariate analysis, the factors that showed significant association with outcome were gender, blood pressure, GCS, breathing pattern, pupillary size, pupillary reaction, papiloedema, and abnormal posturing. Abnormal pupillary size, severe hypertension, and GCS score ≤5 were independent predictors of in-hospital 1-month mortality in nontraumatic coma.Conclusion:The independent important predictors of nontraumatic 1-month coma mortality in a developing country setting were GCS ≤ 5, abnormal pupillary size, and severe hypertension.

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Section: Discussionmentioning

confidence: 99%

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria

Owolabi¹,

Mohammed²,

Dalhat³

et al. 2013

Indian Journal of Critical Care Medicine

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“…Similar results were found by Levy et al [21], who investigated the outcome from hypoxic coma in 210 patients. The most predictive variable at the initial exam ination was the pupillary light reflex, the sign shown to have the least interobserver variability [111,112], None of the 52 patients lacking pupillary reactivity on the initial examination survived with a good outcome or moderate disability. Thereafter, the motor response became the variable having the greatest predictive power.…”

Section: Clinical and Neurological Predictors Of Outcomementioning

confidence: 99%

The Prognostication of Cerebral Hypoxia after Out-of-Hospital Cardiac Arrest in Adults

1997

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Early determination of outcome after out-of-hospital cardiopulmonary resuscitation is a common problem with great ethical, economic, social and legal consequences. Although there has been a fulminant development of emergency medicine during the last three decades, severe cerebral damage sometimes cannot be avoided. For neurological outcome prediction after cardiac arrest clinical neurological signs, electrophysiological examinations, neuroimaging tests, and laboratory parameters in serum and cerebrospinal fluid are used today, nevertheless, there still remains a considerable degree of uncertainty. However, although prognostic criteria which enable the clinician to stop treatment cannot be given at the present time, useful applications of early prognostication after cardiac arrest range from counseling of families, triage decisions, and do-not-resuscitate decisions to future clinical investigations of brain resuscitative measures.

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“…The majority of survivors remain comatose and outcome is variable; some may remain in a vegetative state, while others may eventually recover completely [1]. Absent motor response to pain for more than 2 days, absence of corneal and papillary reflexes for more than 24 h, and persistence of a Glasgow Coma Scale score <5 for more than 2–3 days strongly predict death or poor outcome [2,3,4,5,6,7,8,9,10]. In addition to these clinical signs, a number of neurophysiological and laboratory tests, such as absence of cortical somatosensory evoked potential, CSF creatinine kinase and lactate have been identified as prognostic indicators[10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Prognosis following Postanoxic Myoclonus Status epilepticus

et al. 2005

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Prediction of outcome after cardiac arrest has important ethical and socioeconomic implications. In general, delay in recovery of neurological function is associated with a worse prognosis. The presence of myoclonic seizures early after anoxia has been identified as a poor prognostic factor. We report a series of patients who developed postanoxic myoclonus status epilepticus (MSE), which was defined as continuous myoclonic seizure activity lasting 30 min or more. The results from 18 patients were retrieved, 11 men and 7 women, age ranging from 29 to 90 years. Myoclonus developed a mean of 11.7 h after cardiac arrest, persisting for a mean of 60.5 h. Sixteen (89%) died following MSE and the 2 survivors were highly dependent or remained in a persistent vegetative state, supporting the view that prognosis is poor in this condition.

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Interobserver agreement in assessment of ocular signs in coma.

Cited by 72 publications

References 26 publications

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria

The Prognostication of Cerebral Hypoxia after Out-of-Hospital Cardiac Arrest in Adults

Prognosis following Postanoxic Myoclonus Status epilepticus

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