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Long-term outcome in coma
Prabha P Nayana1, Tiroumourougane V Serane, P Nalini
1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry, India.
Insights
The Modified Glasgow Coma Scale (MGCS) is not useful for predicting long-term outcomes in children with non-traumatic coma. However, the verbal response component of the MGCS strongly correlates with better functional outcomes and intelligence.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
Background:
- Acute non-traumatic coma in children presents diagnostic and prognostic challenges.
- Accurate prediction of long-term functional outcome is crucial for patient management and rehabilitation.
Purpose of the Study:
- To evaluate the predictive value of the Modified Glasgow Coma Scale (MGCS), its components, and brainstem reflexes for long-term functional outcomes in pediatric non-traumatic coma.
- To identify specific clinical indicators that correlate with functional recovery and cognitive status.
Main Methods:
- Children with acute non-traumatic coma were assessed using the MGCS and brainstem reflexes every 6 hours for 72 hours.
- Functional outcome was evaluated at 9 months post-admission using the Glasgow Outcome Scale (GOS) and intelligence quotient (IQ).
- Lowest MGCS scores and worst brainstem reflexes were analyzed, along with multivariate regression.
Main Results:
- Higher total MGCS and verbal response scores showed a significant positive correlation with better GOS and IQ.
- No association was found between language function and initial MGCS or brainstem reflexes.
- Lower verbal response was the sole factor significantly associated with poorer long-term GOS and IQ in multivariate analysis.
Conclusions:
- The overall MGCS is not a reliable predictor of long-term outcomes in pediatric non-traumatic coma.
- The verbal response component of the MGCS is a valuable predictor of long-term functional outcome and intelligence quotient in this patient population.
Objective:
To assess the relationship between Modified Glasgow Coma Scale, its components, brain stem reflexes and long term functional outcome in children with acute non-traumatic coma.
Method:
MGCS and brainstem reflexes were assessed at 6 hourly intervals for 72 hours from the time of admission. The children were followed up regularly and functional outcome was assessed at the end of 9 months. The lowest score of the MGCS and worst brain stem reflexes were used for the analysis.
Results:
Higher total MGCS score and verbal response score had a significant positive correlation with better functional outcome as measured by GOS and intelligence quotient. There was no association between the language function and the initial MGCS, its components and brain stem reflexes. Lower verbal response (P = 0.005) was the only factor that was found to be individually associated with poorer long term GOS score and intelligence quotient by multivariate linear regression analysis.
Conclusion:
In the long term prediction of outcome in acute non-traumatic coma, MGCS is not useful. However, verbal response, a component of MGCS, correlates well with long term functional outcome and intelligence quotient.
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