Prognostic value of initial Glasgow coma score in comatosed patients on medical floor

An open non-randomized prospective observational study of comatosed patients was conducted to correlate initial Glasgow Coma Score [GCS] with the outcome in patients having medical coma at Mayo Hospital, Lahore between January 2002 to September 2003. A total of 273 patients were followed throughout their hospital stay to determine the outcome after the current episode of coma. A thorough history and examination was obtained for each case. The 3 category Glasgow Coma Score was recorded as an indication of the degree of unconsciousness. One of three possible outcome categories was established, recovery [discharge], death, and referral or self discharge [by attendants] against medical advice. The outcome of 248 patients [90.84%] was established i.e. 152 [61.29%] were discharged after recovery and 96 [38.71%] died. The remaining 25 [09.16%] patients were lost to follow up. Four subcategories of the Glasgow Coma Score were made, at 3-point intervals. In the lowest score category [score 3-5] there was 59.67% mortality and only 30.66% patients were successfully treated and discharged. In the category of GCS 6-8, 30.91% died and 60% were discharged, while in the 9-11 category, 26.47% died and 66.18% were discharged. In the highest score category [12-15], 27.27% deaths occurred, probably related to the severity of main event, and 62.50% were discharged. The depth of coma as reflected by the initial GCS can reliably be used to predict the outcome in comatosed patients

there any relationship of age and sex to the etiology and outcome of medical coma?

As the diseases behave differently in males and females and even in different age groups, particular attention was made to classify and observe the distribution of various causes of coma according to age and sex of the patient in order to formulate our indigenous database for future reference. We studied the coma etiology with particular reference to the age and sex of the patient, and the outcome. All the 517 [312 male [60.35%] and 205 female [39.65%]] patients were divided into 7 groups according to decades from age 12 to 80 years. Patients older than 40 years predominated [318 [61.5%]]. Metabolic coma was predominant cause in almost all age groups. Structural coma was increasing progressively with the age. Poisonings were the common cause in patients under 30, representing 35.85% of all comas in the age group 12-20, and 33.70% in the group from 21-30 years. In the next two decades [31-50 years], hepatic and renal failure predominated making up more than half of all causes. Leading causes among males we re poisonings [69 cases], hemorrhagic CVA [48 cases], ischemic CVA [24 cases], renal failure [28 cases] and hepatic coma [35 cases]. Similarly among females causal distribution revealed renal failure [34 cases], followed by hepatic coma [29 cases], and hemorrhagic CVA [26 cases]. Out of the 476 [92%] patients whose outcome could be determined 297 [57.4%] were discharged after recovery and 179 [34.6%] died. Eighty out of 205 female patients died [39%], while 99 out of 312 males had a fatal outcome [31.7%]. We conclude that coma etiology has a significant effect on prognosis, while such significance could not be assigned to age or sex