Poster 131: Evaluation of anoxic brain injuries in children using the coma/near coma scale.

Abstract

Objective: To evaluate the role that admission coma level plays in predicting recovery from coma secondary to anoxic brain injury. Design: Retrospective cohort review of pediatric anoxic brain injuries. Setting: Inpatient neurotrauma rehabilitation care unit. Participants: 13 patients identified on admission with a diagnosis of anoxic brain injury and in a state of “moderate” to “extreme” coma, as determined by evaluation using the Coma/Near Coma (CNC) Scale. Interventions: Not applicable. Main Outcome Measure: CNC score. Scoring system rates level of coma on a scale ranging from 4 (extreme) to 0 (no coma). Results: Patients in coma with a diagnosis of anoxic brain injury of varying etiology were scored on admission and at discharge. A discussion of extent of recovery between admission and discharge and how this relates to various parameters is presented. All 13 patients were in a state of moderate to extreme coma (CNC score, >2.01), with 70% (n=9) in the marked to extreme coma range (CNC score, >2.9). Regardless of their initial score, 46% (n=5) improved to a state of near to no coma (CNC score, <2). Of the 13 patients reviewed, 23% (n=3) made no improvements at all. Conclusions: In this small cohort, level of coma on admission was not predictive of recovery from a comatose state. A high percentage (46%) of these children were discharged in a state of near to no coma, independent of admission coma level. This does not suggest, however, that recovery from coma is predictive of long-term cognitive and motor recovery. Assessment of long-term outcomes to further evaluate the capacity for recovery from anoxic brain injury is indicated.