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

ABSTRACT

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