Prognosis in presumptive hypoxic-ischemic coma in nonneurologic trauma

Jen Feng Fang, Ray Jade Chen, Being Chuan Lin, Yu Bau Hsu, Jung Liang Kao, Yi Chin Kao, Miin Fu Chen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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. Conclusion: 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.

Original languageEnglish
Pages (from-to)1122-1125
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume47
Issue number6
Publication statusPublished - Dec 1999
Externally publishedYes

Fingerprint

Coma
Nervous System
Wounds and Injuries
Pupillary Reflex
Craniocerebral Trauma
Light
Blood Glucose
Respiration
Seizures
Hemodynamics
Induced Heart Arrest
Mortality
Neurologic Manifestations
Heart Arrest
Resuscitation
Decision Making
Survival
Brain

Keywords

  • Hypoxic-ischemic coma
  • Neurologic deficit
  • Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Fang, J. F., Chen, R. J., Lin, B. C., Hsu, Y. B., Kao, J. L., Kao, Y. C., & Chen, M. F. (1999). Prognosis in presumptive hypoxic-ischemic coma in nonneurologic trauma. Journal of Trauma - Injury, Infection and Critical Care, 47(6), 1122-1125.

Prognosis in presumptive hypoxic-ischemic coma in nonneurologic trauma. / Fang, Jen Feng; Chen, Ray Jade; Lin, Being Chuan; Hsu, Yu Bau; Kao, Jung Liang; Kao, Yi Chin; Chen, Miin Fu.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 47, No. 6, 12.1999, p. 1122-1125.

Research output: Contribution to journalArticle

Fang, JF, Chen, RJ, Lin, BC, Hsu, YB, Kao, JL, Kao, YC & Chen, MF 1999, 'Prognosis in presumptive hypoxic-ischemic coma in nonneurologic trauma', Journal of Trauma - Injury, Infection and Critical Care, vol. 47, no. 6, pp. 1122-1125.
Fang, Jen Feng ; Chen, Ray Jade ; Lin, Being Chuan ; Hsu, Yu Bau ; Kao, Jung Liang ; Kao, Yi Chin ; Chen, Miin Fu. / Prognosis in presumptive hypoxic-ischemic coma in nonneurologic trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 1999 ; Vol. 47, No. 6. pp. 1122-1125.
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